Little People's Church 26-27
Please fill out this form and click submit.
Level 1 - for Preschoolers Ages 3 & 4
Level 2 - for Kindergarteners & 1st Graders
Child #1
Name (First & Last)
*
Birth Date
*
School & Grade (if applicable)
*
Level?
*
Please select one option.
Level 1
Level 2
Select Option
Level 1
Level 2
Child #2
Name
Birth Date
School & Grade (if applicable)
Level?
Please select one option.
Level 1
Level 2
Select Option
Level 1
Level 2
Child #3
Name
Birth Date
School & Grade (if applicable)
Level?
Please select one option.
Level 1
Level 2
Select Option
Level 1
Level 2
Parent/Guardian #1
Name
*
Email
*
This address will receive a confirmation email
Phone
*
OK to send text reminders?
*
Please select one option.
yes
no
Select Option
yes
no
Address
*
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Parent/Guardian #2
Name
Email
Phone
OK to send text reminders?
Please select one option.
yes
Option
Select Option
yes
Option
Health & Emergency Information
Emergency Contact (other than parent)
*
Emergency Contact Phone
*
Any chronic illnesses, allergies or other conditions we should be aware of in working with this child (these children)?
*
Photo Release
I hereby authorize St. Aloysius Parish to take & publish the photographs and videos taken of my child/dependent and/or their name, for use in printed publications, website, social media platforms, and training purposes. I acknowledge that since participation in publications and websites produced by St. Aloysius Parish is voluntary, I will not receive financial compensation. I further agree that participation in any publication and website produced by St. Aloysius Parish confers no rights of ownership whatsoever. I release St. Aloysius Parish its contractors, and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children.
Please select one
*
Please select one option.
YES – I grant permission to take and use my child’s photo
NO – Please do not use any photographs of my child. I know that they won’t be removed from classes or celebrations but will be positioned in a way so that they will not be in photos.
Select Option
YES – I grant permission to take and use my child’s photo
NO – Please do not use any photographs of my child. I know that they won’t be removed from classes or celebrations but will be positioned in a way so that they will not be in photos.
Electronic Signature (please type full name)
*
Submit
Description
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