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

Parent's First Names REQUIRED Please fill out this field. Please enter valid data.

Street 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.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

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

Father's Information

Father's Address (if different from above) Please enter valid data.

Father's Religion Please enter valid data.

Father's Work Phone Please enter a phone number.

Father's Cell Phone Please enter a phone number.

Father's Email Please enter an email address.

Mother's Information

Mother's Address (if different from above) Please enter valid data.

Mother's Religion Please enter valid data.

Mother's Work Phone Please enter a phone number.

Mother's Cell Phone Please enter a phone number.

Mother's Email Please enter an email address.

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone REQUIRED Please fill out this field. Please enter a phone number.

Photography Release
We would like your permission to use pictures that may be taken during class in the following ways:
-On the Parish website
-On the Parish official Facebook page
-On the Parish bulletin boards
-In the Parish bulletin
-In The Observer (Diocese of Rockford Newspaper)

Are you ok with us taking and using photos of your child(ren) in the above listed ways? REQUIRED Yes No Please fill out this field.

Are you ok with your child(ren)'s name being used with pictures? REQUIRED Yes No Please fill out this field.

Student Information (Child #1)

First Name REQUIRED Please fill out this field. Please enter valid data.

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

Sex REQUIRED Male Female Please fill out this field.

Special Needs? REQUIRED Yes No Please fill out this field.

I would like my student taught: REQUIRED Sunday Faith Formation Family Faith Formation Please fill out this field.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

School Attending: Please enter valid data.

Grade Level in Fall 2022 Please enter valid data.

Medical Release Information

Best # to call in case of an emergency: REQUIRED Please fill out this field. Please enter a phone number.

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

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

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

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

List specific medical allergies, chronic illnesses, learning disabilities or other health or learning concerns that may affect classroom behavior:

This release form is for the duration of this Religious Education class year for your child(ren). I have completed this form and agreed of my own free will with the sole purpose of authorizing medical treatment, under emergency circumstances, in my absence. I will notify the Religious Education Office immediately if any of the above information should change at any times.

I Agree Please select this field.

Student Information (Child #2)

First Name Please enter valid data.

Last Name Please enter valid data.

Sex Male Female

Special Needs? Yes No

I would like my student taught: Sunday Faith Formation Family Faith Formation

Date of Birth Please enter a date.

School Attending: Please enter valid data.

Grade Level in Fall 2022 Please enter valid data.

Medical Release Information

Best # to call in case of an emergency: Please enter a phone number.

Physician's Name Please enter valid data.

Phone Number Please enter a phone number.

Dentist's Name Please enter valid data.

Phone Number Please enter a phone number.

List specific medical allergies, chronic illnesses, learning disabilities or other health or learning concerns that may affect classroom behavior:

Student Information (Child #3)

First Name Please enter valid data.

Last Name Please enter valid data.

Sex Male Female

Special Needs? Yes No

I would like my student taught: Sunday Faith Formation Family Faith Formation

Date of Birth Please enter a date.

School Attending: Please enter valid data.

Grade Level in Fall 2022 Please enter valid data.

Medical Release Information

Best # to call in case of an emergency: Please enter a phone number.

Physician's Name Please enter valid data.

Phone Number Please enter a phone number.

Dentist's Name Please enter valid data.

Phone Number Please enter a phone number.

List specific medical allergies, chronic illnesses, learning disabilities or other health or learning concerns that may affect classroom behavior:

Student Information (Child #4)

First Name Please enter valid data.

Last Name Please enter valid data.

Sex Male Female

Special Needs? Yes No

I would like my student taught: Sunday Faith Formation Family Faith Formation

Date of Birth Please enter a date.

School Attending: Please enter valid data.

Grade Level in Fall 2022 Please enter valid data.

Medical Release Information

Best # to call in case of an emergency: Please enter a phone number.

Physician's Name Please enter valid data.

Phone Number Please enter a phone number.

Dentist's Name Please enter valid data.

Phone Number Please enter a phone number.

List specific medical allergies, chronic illnesses, learning disabilities or other health or learning concerns that may affect classroom behavior:

Student Information (Child #5)

First Name Please enter valid data.

Last Name Please enter valid data.

Sex Male Female

Special Needs? Yes No

I would like my student taught: Sunday Faith Formation Family Faith Formation

Date of Birth Please enter a date.

School Attending: Please enter valid data.

Grade Level in Fall 2022 Please enter valid data.

Day Care Needs

Please fill our Medical Release Form below and list any physical, emotional or learning needs that may affect your child's experience.

Do you need daycare for Family Faith Formation? Yes No

Child #1 Name and Age: Please enter valid data.

Child #2 Name and Age: Please enter valid data.

Child #3 Name and Age: Please enter valid data.

Child #4 Name and Age: Please enter valid data.

Medical Release Information

Best # to call in case of an emergency: Please enter a phone number.

Physician's Name Please enter valid data.

Phone Number Please enter a phone number.

Dentist's Name Please enter valid data.

Phone Number Please enter a phone number.

List specific medical allergies, chronic illnesses, learning disabilities or other health or learning concerns that may affect classroom behavior:

St. Patrick Catholic Church

Like the Apostles, we "recognize Him, Jesus,
in the breaking of the bread."

Religious Education

2023-24 Classes

Printable Forms and School Year Information

Religious Ed Online Registration

Student Information (Child #1)

Student Information (Child #2)

Student Information (Child #3)

Student Information (Child #4)

Student Information (Child #5)

Day Care Needs

Medical Release Information