Family Model K-5th Grade Registration

Put N/A in any box that cannot be completed but is required for submission.

Preferred language for materials/ Idioma preferido para los materiales REQUIRED Please fill out this field.

Parent/Guardian 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.

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.

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

Other Phone Number Please enter a phone number.

Are you a registered parishioner? REQUIRED Please fill out this field.

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

Parent/Guardian 2

First Name Please enter valid data.

Last Name Please enter valid data.

Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Cell Phone Number Please enter a phone number.

Other Phone Number Please enter a phone number.

Are you a registered parishioner?

Email Please enter an email address.

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

Emergency Contact During Class Time

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

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

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

Children 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.
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex as indicated on birth certificate REQUIRED Please fill out this field.
- Grade Level in Fall REQUIRED Please fill out this field.
- Language REQUIRED Please fill out this field.
- Please Check which Sacraments your Child has received REQUIRED Baptism First Eucharist Confirmation None Received Please fill out this field.
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.
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex as indicated on birth certificate REQUIRED Please fill out this field.
- Grade Level in Fall REQUIRED Please fill out this field.
- Language REQUIRED Please fill out this field.
- Please Check which Sacraments your Child has received REQUIRED Baptism First Eucharist Confirmation None Received Please fill out this field.
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.
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex as indicated on birth certificate REQUIRED Please fill out this field.
- Grade Level in Fall REQUIRED Please fill out this field.
- Language REQUIRED Please fill out this field.
- Please Check which Sacraments your Child has received REQUIRED Baptism First Eucharist Confirmation None Received Please fill out this field.
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.
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex as indicated on birth certificate REQUIRED Please fill out this field.
- Grade Level in Fall REQUIRED Please fill out this field.
- Language REQUIRED Please fill out this field.
- Please Check which Sacraments your Child has received REQUIRED Baptism First Eucharist Confirmation None Received Please fill out this field.
Child 5
- 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 of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex as indicated on birth certificate REQUIRED Please fill out this field.
- Grade Level in Fall REQUIRED Please fill out this field.
- Language REQUIRED Please fill out this field.
- Please Check which Sacraments your Child has received REQUIRED Baptism First Eucharist Confirmation None Received Please fill out this field.
Child 6
- 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 of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex as indicated on birth certificate REQUIRED Please fill out this field.
- Grade Level in Fall REQUIRED Please fill out this field.
- Language REQUIRED Please fill out this field.
- Please Check which Sacraments your Child has received REQUIRED Baptism First Eucharist Confirmation None Received Please fill out this field.
Child 7
- 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 of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex as indicated on birth certificate REQUIRED Please fill out this field.
- Grade Level in Fall REQUIRED Please fill out this field.
- Language REQUIRED Please fill out this field.
- Please Check which Sacraments your Child has received REQUIRED Baptism First Eucharist Confirmation None Received Please fill out this field.
Child 8
- 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 of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex as indicated on birth certificate REQUIRED Please fill out this field.
- Grade Level in Fall REQUIRED Please fill out this field.
- Language REQUIRED Please fill out this field.
- Please Check which Sacraments your Child has received REQUIRED Baptism First Eucharist Confirmation None Received Please fill out this field.
Child 9
- 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 of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex as indicated on birth certificate REQUIRED Please fill out this field.
- Grade Level in Fall REQUIRED Please fill out this field.
- Language REQUIRED Please fill out this field.
- Please Check which Sacraments your Child has received REQUIRED Baptism First Eucharist Confirmation None Received Please fill out this field.

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

Doctor's Phone Number REQUIRED Please fill out this field. Please enter valid data.

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

Insurance Group Number REQUIRED Please fill out this field. Please enter valid data.

Insurance Phone Number REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian Electronic Signature REQUIRED Please fill out this field. Please enter valid data.

Medical Consent

In the event of an emergency, I hereby give permission to the staff of St. Thomas More Catholic Church to seek emergency medical transport and/or treatment for my child(ren) named above. I will be responsible for all costs incurred. I wish to be advised before further care is given by the hospital or dorctor.

I Agree Please select this field.

Video/Photography Consent

As parent/guardian, I understand that promotional pictures and videos ( individual and group) may be taken during the classes and activities. I give permission for my child(ren)'s pictures (named above) to be used for church promotional materials such as newsletters, web pages, calendars, Power Point presentations, or videos to promote or highlight activities of the children in their Faith Formation classes.

I Agree Please select this field.

Consent and Liability Waver

In the event of any accident or injury, I agree on behalf of myself, my child(ren)'s other parent if known or living, the child(ren) named above or our heirs, successors, and assigns, to hold harmless and defend the Archdiocese of Galveston-Houston, its pastor or any representative of Faith Formation, unless the parties involved were careless and negligent. Effective for all Faith Formation activities at St. Thomas More.

I Agree Please select this field.

Accommodations, Support, Health, or Allergy Concerns? REQUIRED Please fill out this field.

I grant permission for my information to be submitted to Flocknote so that the CCE department can communicate with me. I recognize that this is the primary mode through which information regarding CCE will be transmited.

I Agree Please select this field.

Family Model CCE Cost for Registered Parishioners100.0

Are you a registered parishioner? If you select yes, but you are not a registered parishioner we will not consider you registration complete and you will be charged the non-parishioner fee in order to complete the registration. REQUIRED

0.0 – Yes

100.0 – No Please fill out this field.

**NO REFUNDS**

Your registration will not be complete untill you have paid in full. If you need financial assistance, you can reach the parish office at 713-729-0221.

ST. THOMAS MORE

CATHOLIC CHURCH

"A Family of Families"

Family Model K-5th Grade Registration

A Family of Faith

Family K-5 CCE Registration Form