Returning Student Registration Form

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Family Information
- Last Name REQUIRED Please fill out this field. Please enter valid data.
- Parent/Guardian Name(s) REQUIRED Please fill out this field. Please enter valid data.
- Has your mailing address or contact info changed since last year? REQUIRED Yes No Please fill out this field.
- If so, please update it here. If not, leave blank. Please enter valid data.
- Mom's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Dad's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Mom's Email REQUIRED Please fill out this field. Please enter an email address.
- Dad's Email REQUIRED Please fill out this field. Please enter an email address.
- Children to Register REQUIRED Please fill out this field.
- Child 1
  - First Name Please enter valid data.
    
    Last Name Please enter valid data.
  - Grade
  - Virtual Learning or Classroom Learning Virtual Classroom
  - Email for Class Invite (Virtual Learning Only) Please enter an email address.
  - Has your child had any health changes we should know about? Please enter valid data.
- Child 2
  - First Name Please enter valid data.
    
    Last Name Please enter valid data.
  - Grade
  - Virtual Learning or Classroom Learning Virtual Classroom
  - Email for Class Invite (Virtual Learning Only) Please enter an email address.
  - Has your child had any health changes we should know about? Please enter valid data.
- Child 3
  - First Name Please enter valid data.
    
    Last Name Please enter valid data.
  - Grade
  - Virtual Learning or Classroom Learning Virtual Classroom
  - Email for Class Invite (Virtual Learning Only) Please enter an email address.
  - Has your child had any health changes we should know about? Please enter valid data.
- Child 4
  - First Name Please enter valid data.
    
    Last Name Please enter valid data.
  - Grade
  - Virtual Learning or Classroom Learning Virtual Classroom
  - Email for Class Invite (Virtual Learning Only) Please enter an email address.
  - Has your child had any health changes we should know about? Please enter valid data.
Parent/Guardian Agreement
- I understand that I, as parent or legal guardian of the child listed above, am required to read the Parent Handbook provided by the Religious Education program at St. John Catholic Parish. I understand and agree to abide by the guidelines, rules and regulations set forth in this handbook. I understand that my child(ren) need(s) to observe the basic rules of conduct, and adhere to the rules stated in the handbook. I understand that failure to comply with the family handbook could bring about disciplinary actions including, in extreme cases, dismissal of my child from the catechetical program.
  
  I understand that I am responsible for sharing the rules, regulations and other important information in this handbook with my child.
  
  I Agree Please select this field.
- Signature (PRINT FULL NAME IN ALL CAPS) REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
Pickup Authorization
- We encourage all parents to come into the classroom when dropping off or picking up your children. If your child is the 4th grade or lower, it is mandatory that someone come into the classroom to pick up your child. If a sibling will pick up your child, they must be in the 5thgrade or higher.
  
  Please list all who have permission to pick up your child:
- Who can pickup your child? REQUIRED Please fill out this field. Please enter valid data.
Medical Release
- As a parent and/or guardian, I do herewith authorize the treatment of my child by a qualified and licensed medical doctor of the following minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after reasonable effort has been made to reach me first or the emergency contact person listed below.
- Emergency Contact REQUIRED Please fill out this field.
- Emergency Contact 1
  - First Name Please enter valid data.
    
    Last Name Please enter valid data.
  - Relationship to Child Please enter valid data.
  - Phone Number Maximum 20 characters Please enter a phone number.
  - Email Please enter an email address.
- Emergency Contact 2
  - First Name Please enter valid data.
    
    Last Name Please enter valid data.
  - Relationship to Child Please enter valid data.
  - Phone Number Maximum 20 characters Please enter a phone number.
  - Email Please enter an email address.
- Emergency Contact 3
  - First Name Please enter valid data.
    
    Last Name Please enter valid data.
  - Relationship to Child Please enter valid data.
  - Phone Number Maximum 20 characters Please enter a phone number.
  - Email Please enter an email address.
- Emergency Contact 4
  - First Name Please enter valid data.
    
    Last Name Please enter valid data.
  - Relationship to Child Please enter valid data.
  - Phone Number Maximum 20 characters Please enter a phone number.
  - Email Please enter an email address.
This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence and only after all efforts have been made to reach me or the emergency contact person(s) listed.
I Agree Please select this field.
Signature of Parent or Guardian (TYPE NAME IN ALL CAPS) REQUIRED Please fill out this field. Please enter valid data.
Date REQUIRED Please fill out this field. Please enter a date.
4 + 6 = REQUIRED Please fill out this field. Please enter valid data.

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St. John the Baptist

Grand Bay, AL

Returning Student Registration Form

Returning Student Registration (Family)