Faith Formation Registration <div> 2019-2020 </div>

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.
Email REQUIRED Please fill out this field. Please enter an email address.
Are you a registered parishioner? REQUIRED Please fill out this field.

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.
Email 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.
- Sex
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED 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.
- Sex
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED 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.
- Sex
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED 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.
- Sex
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED 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.
- Sex
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED 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.
- Sex
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED 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.
- Sex
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED 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.
- Sex
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED 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.
- Sex
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED Please fill out this field.
Child 10
- 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
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED Please fill out this field.
Child 11
- 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
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED Please fill out this field.
Child 12
- 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
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Grade Level in Fall 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.
- Class Times REQUIRED Pre-K 3 and 4 Sunday 8:15 am - 9:15 am Pre-K 3 and 4 Sunday 9:35 am - 10:35 am Pre-K 3 and 4 Sunday 11:00 am - 12 pm Pre-K 3 and 4 Sunday 4:00 pm - 5:15 pm Elementary Sunday 9:30 am - 10:45 am Elementary Sunday 4:00 pm - 5:15 pm Elementary - Home Study Jr. High Sunday 4:00 pm - 5:15 pm Jr. High - Home Study High School Sunday 4:00 pm - 5:15 pm Please fill out this field.
- Faith Formation 2019-2020 Registration Fees REQUIRED 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 a phone number.

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. Bernadette 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.
Please Check One REQUIRED I Agree I Do Not Agree Please fill out 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. Bernadette Catholic Church.
I Agree Please select this field.

Faith Formation Handbook

I have read and agree to the policies of the Faith Formation Handbook (found here) for the child(ren) named above.
I Agree Please select this field.

Accommodations, Support, Health, or Allergy Concerns? REQUIRED

Please give child(ren)'s name and explain

Please fill out this field.

St. Bernadette
Catholic Church

15500 El Camino Real Houston, TX 77062

St. Bernadette Catholic Church
Archdiocese of Galveston-Houston

Office Hours