Home Phone *

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Mother's Cell

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Mother's Work Phone

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Father's Cell

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Father's Work Phone

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*

Male

Female

Birthdate *

MM

DD

YYYY

My child has received the following Sacraments (choose all that apply) *

Baptism (Catholic)

Baptism (Non-Catholic)

Reconciliation

Eucharist

Confirmation

I am interested in being a Family Faith Formation Small Group Mentor *

Yes

No

Possibly, but I would like more information

Are there any parental custodial circumstances that might affect your child's attendance? *

Yes

No

Does your child have a medical condition, food allergies, or behavioral problems? *

Yes

No

In the event that a parent/guardian cannot be reached, I hereby give my consent to St. Charles Borromeo Catholic Church to contact the physician listed above, and, if necessary, transport my child to a clinic or hospital *

I agree

I do not agree

I hereby give St. Charles Borromeo Catholic Church permission to publish pictures of my child on the parish website, social media, and/or parish publications. (Please note: No names will be included with pictures).

I agree

I do not agree

I have had the opportunity to review the St. Charles Borromeo Youth Handbook and agree to abide by the policies of the Handbook. *

Click Here to Affirm