Family Faith Formation 2020-2021

Are you currently a registered parishioner of Christ the King Parish? REQUIRED Yes No Please fill out this field.

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Home Phone Please enter a phone number.

Primary Email REQUIRED Please fill out this field. Please enter an email address.

Mother's Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Cell REQUIRED Please fill out this field. Please enter a phone number.

Mother's Work Please enter a phone number.

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Father's Cell REQUIRED Please fill out this field. Please enter a phone number.

Father's Work Phone Please enter a phone number.

Special Circumstances

Please indicate below any special circumstances regarding your child or family. If the allergy is potentially life-threatening, please meet with the Director to discuss. THIS INFORMATION WILL BE TREATED AS CONFIDENTIAL.
Custodial care is with REQUIRED Please fill out this field.
Are there any parental custodial circumstances that might affect your child's attendance? REQUIRED Yes No Please fill out this field.
If yes, please explain. Please enter valid data.
Does your child have a medical condition, food allergies, or behavioral issues? REQUIRED Yes No Please fill out this field.
If yes, please explain. Please enter valid data.
Emergency Contact #1 - Name | Phone | Relationship REQUIRED Please fill out this field. Please enter valid data.
Emergency Contact #2 - Name | Phone | Relationship REQUIRED Please fill out this field. Please enter valid data.
Physician - Name | Phone REQUIRED Please fill out this field. Please enter valid data.

In the event that a parent/guardian cannot be reached, I hereby give my consent to Christ the King Catholic Church to contact the physician listed above, and, if necessary, transport my child to a clinic or hospital REQUIRED I agree I do not agree Please fill out this field.

I hereby give Christ the King 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). REQUIRED I agree I do not agree Please fill out this field.

Method of payment (online giving will be available soon!) REQUIRED Please fill out this field.