Kids' Creed Registration 2011-12
Grades 1 - 6

Looking for RAFT registration (Middle School, Grades 7-8)? Click here!

Family Information

Family LAST Name: E-mail Address:
Street Address: City, State, Zip:
Home Phone: Cell Phone:
             
Student
Full Name		 Grade Gender Birthdate School Pick a Session Received
Sacraments of
Reconciliation &
Eucharist?
     
Parent/Guardian: Day Phone: Work Phone:
Parent/Guardian: Day Phone: Work Phone:

Medical Information

Please list student and explain ANY CURRENT MEDICATIONS, health conditions, and/or disabilities (e.g., diabetes, epilepsy, severe allergies, vision/hearing impairment, learning disability, etc.)
Student Name: Condition(s):
Student Name: Condition(s):

Pick Up Information

PERSONS AUTHORIZED TO PICK YOUR CHILD UP FROM GOOD SHEPHERD IN THE EVENT OF AN EMERGENCY WHEN YOU CANNOT BE LOCATED: (You must list at least two names and numbers.)
Name Relationship Address Phone(s)

Hospital
IN AN EXTREME EMERGENCY: If your child should become seriously ill or injured at Good Shepherd and you and the physician cannot be reached within a reasonable length of time, may we have permission to take appropriate action to see that your child gets emergency hospital care?

Hospital Preference 

Physician Name  Phone 
 

We Need You!

Are you interested in volunteering? We’ll be happy to add you to our team! If you would like to help, please call Debbie Carmody at 563-5303 BEFORE SENDING IN YOUR FINALIZATION PAPERS.

Comments

Please list any additional comments or information: