Faith Formation New Student Form Faith Formation New Student Registration Child's Name* First Last Nickname Date of Birth* Month Day Year Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone*Cell Phone*Family Email* Parish* Immaculate Conception Other Please identify Parish if not Immaculate Conception School Attending in September* Grade Entering in September*Kindergarten1st2nd3rd4th5th6th7th8thFather's Name* First Last Father's Religion Mother's Name* First Last Mother's Religion Does your child have an allergies, medical conditions or educational needs that we should be aware of?* Yes No If you answered YES to the question above, please describe the condition or need.Emergency ContactEmergency Contact Name* First Last Emergency Contact Phone*Online Learning ConsentVirtual On-Line Learning Permission: If necessary, my child has my permission to participate with on-line Catechesis with Immaculate Conception. I understand that a subsequent email will be forwarded providing the dates and times of the sessions.* I give permission. I DO NOT permission. Parent Name* Media ReleasePhotographs and/or videos of minors are taken periodically for use in parish publications. In checking "I agree" you are acknowledging this and granting permission to Immaculate Conception Faith Formation to use photos and videos of your child and their names in print/electronic publications and displays.* I agree. I do NOT agree. Parent Name* Sacramental RecordPrevious Religious Education* Yes No If your child had previous religious education please indicate where. Baptism Date Month Day Year Baptism Church and City First Reconciliation Date Month Day Year First Reconciliation Church and City First Eucharist Date Month Day Year First Eucharist Church and City MM slash DD slash YYYY School Year 2021-2022Faith Formation Grade Entering*Kindergarten1st2nd3rd4th5th6th7th8thClass Requested* Weekday Sunday Volunteer InformationWe are always in need of additional teachers, substitutes and adult helpers. Please prayerfully consider helping out. Please select one of the ways listed below if you can assist us. Teacher Aide or Assistant Substitute Teacher PaymentPlease indicate your payment method.* Cash/Check (Please mail or drop in the rectory door mail slot at Parish Office.) Online payment (Once you submit this form you will receive a pop up that will provide a link to pay online.) Fee is $30.00 per child for IC Parishioners, maximum of $90.00 per family (3 or more) $40.00 per child for non-parishioners, $120.00 per family (3 or more) Registration is due by August 1st. Any received after this date must include a $10 late fee.