2022/2023 FAMILY FAITH FORMATION REGISTRATION FORM

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

Father's Full Legal Name

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

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

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

Mother's Full Legal Name:

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Mother's Maiden Name: REQUIRED Please fill out this field. Please enter valid data.
Mother's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

Marital Status: REQUIRED Married Single Separated Divorced Widowed Please fill out this field.

Child Custody: REQUIRED Father Mother Both Legal Guardian (Documentation Required) Please fill out this field.

Family 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.

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

Secondary Email Please enter an email address.

Emergency Contact Name & Relationship Please enter valid data.

Emergency Contact Phone Number Please enter a phone number.

Authorized Family Pick-Up Contacts: Please include name, relationship and phone number.

Are you interested in volunteering in the classroom? Yes ((requires Diocesan Background Clearance No I need more information

Number of Children Registering for Classes: REQUIRED Please fill out this field.
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.
- Child's Middle Name: REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- City & State of Birth REQUIRED Please fill out this field. Please enter valid data.
- Gender
- Has the child been baptized? REQUIRED Yes No Please fill out this field.
- Was child baptized at St. Luke Catholic Church? Yes No
- * A copy of the child's baptism certificate must be on file prior to the first day of classes. Please email a copy to: laura@stlukesparish.org.
- School Year for Grade 2022/2023 REQUIRED K 1st 2nd 2nd combined with First Sacrament Classes 3rd 4th 5th 6th 7th (1st Year Confirmation Prep) 8th (Confirmation) High School Please fill out this field.
- Name of School Attending Please enter valid data.
- Last location and year of Religious Education attendance REQUIRED Please fill out this field. Please enter valid data.
- List of all Sacraments received - Please include date and location
- Special needs or considerations that we should be aware of: REQUIRED Please fill out this field. Please enter valid data.
- How can we best teach your child? REQUIRED Please fill out this field.
- Allergies REQUIRED Please fill out this field. Please enter valid data.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Middle Name: REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- City & State of Birth REQUIRED Please fill out this field. Please enter valid data.
- Gender
- Has the child been baptized? REQUIRED Yes No Please fill out this field.
- Was child baptized at St. Luke Catholic Church? Yes No
- * A copy of the child's baptism certificate must be on file prior to the first day of classes. Please email a copy to: laura@stlukesparish.org.
- School Year for Grade 2022/2023 REQUIRED K 1st 2nd 2nd combined with First Sacrament Classes 3rd 4th 5th 6th 7th (1st Year Confirmation Prep) 8th (Confirmation) High School Please fill out this field.
- Name of School Attending Please enter valid data.
- Last location and year of Religious Education attendance REQUIRED Please fill out this field. Please enter valid data.
- List of all Sacraments received - Please include date and location
- Special needs or considerations that we should be aware of: REQUIRED Please fill out this field. Please enter valid data.
- How can we best teach your child? REQUIRED Please fill out this field.
- Allergies REQUIRED Please fill out this field. Please enter valid data.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Middle Name: REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- City & State of Birth REQUIRED Please fill out this field. Please enter valid data.
- Gender
- Has the child been baptized? REQUIRED Yes No Please fill out this field.
- Was child baptized at St. Luke Catholic Church? Yes No
- * A copy of the child's baptism certificate must be on file prior to the first day of classes. Please email a copy to: laura@stlukesparish.org.
- School Year for Grade 2022/2023 REQUIRED K 1st 2nd 2nd combined with First Sacrament Classes 3rd 4th 5th 6th 7th (1st Year Confirmation Prep) 8th (Confirmation) High School Please fill out this field.
- Name of School Attending Please enter valid data.
- Last location and year of Religious Education attendance REQUIRED Please fill out this field. Please enter valid data.
- List of all Sacraments received - Please include date and location
- Special needs or considerations that we should be aware of: REQUIRED Please fill out this field. Please enter valid data.
- How can we best teach your child? REQUIRED Please fill out this field.
- Allergies REQUIRED Please fill out this field. Please enter valid data.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Middle Name: REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- City & State of Birth REQUIRED Please fill out this field. Please enter valid data.
- Gender
- Has the child been baptized? REQUIRED Yes No Please fill out this field.
- Was child baptized at St. Luke Catholic Church? Yes No
- * A copy of the child's baptism certificate must be on file prior to the first day of classes. Please email a copy to: laura@stlukesparish.org.
- School Year for Grade 2022/2023 REQUIRED K 1st 2nd 2nd combined with First Sacrament Classes 3rd 4th 5th 6th 7th (1st Year Confirmation Prep) 8th (Confirmation) High School Please fill out this field.
- Name of School Attending Please enter valid data.
- Last location and year of Religious Education attendance REQUIRED Please fill out this field. Please enter valid data.
- List of all Sacraments received - Please include date and location
- Special needs or considerations that we should be aware of: REQUIRED Please fill out this field. Please enter valid data.
- How can we best teach your child? REQUIRED Please fill out this field.
- Allergies REQUIRED Please fill out this field. Please enter valid data.

Medical Matters
Diocese of St. Augustine
Catholic Center
11625 Old St. Augustine Rd.
Jacksonville, Fl 32258

To my knowledge, my child is in good health, and I assume all responsibility for the health of my child.

In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.

Medical Matters REQUIRED I Agree I disagree Please fill out this field.

Media Release
Diocese of St. Augustine
Catholic Center
11625 Old St. Augustine Rd.
Jacksonville, Florida 32258

Child Photography Release Form

Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures. In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.

Media Release REQUIRED I Agree I Disagree Please fill out this field.

Assumption of Risk and Waiver of Liability Relating to COVID-19

The novel coronavirus (“COVID-19”) has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly through person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. St. Luke Catholic Church has put in place preventative measures to reduce the spread of COVID-19; however, we cannot guarantee that you or your child(ren) will not become infected with COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending programs offered by the parish and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the parish may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff , coaches, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at any parish sponsored programming (“claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless St. Luke Catholic Church and the Diocese of St. Augustine, and all of their current, former, and future agents, representatives, religious and employees and related entities (collectively, “the Diocese”) of and from the claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions or omissions of the Diocese, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any parish program.

Assumption of Risk REQUIRED I Agree I Disagree Please fill out this field.

Signature

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

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

2022/2023 FAMILY FAITH FORMATION REGISTRATION FORM

Register for Family Faith Formation, Confirmation, & First Sacrament Classes

Family Faith Formation Fees: