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Family 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.
Phone Number REQUIRED Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Which church do you attend most frequently? Please enter valid data.
The following individuals would like to register for this year's faith formation program (First name, last name and grade (if child)) REQUIRED Please fill out this field.
Our household would like to take part in the four in person gatherings this year. Yes No
My child/children will be preparing for First Reconciliation and First Communion this year Yes Not Applicable
My child/children will be preparing for Confirmation Yes Not Applicable
My 6th or 7th grader(s) will participate in Jr High Youth Ministry this year Yes Not Applicable
My 8th through 12th grader(s) will participate in Sr. High Youth Ministry this year Yes Not Applicable
Someone in my household is interested in becoming Catholic Yes Not Applicable
Please list any allergies you child/children may have
Emergency contact information for parents/guardians
I give permission for pictures to be taken of my child/children for informational and/or advertising purposes, both online and in print, for church programs only. Yes No
By checking this box,
- I certify that the submitted information is correct, current and complete.
- I give permission for my child to be transported for medical or other emergency purposes.
- I give permission for release of medical records to an attending physician in case of illness.
- In case of medical emergency, I understand that every efort will be made to contact the parents or guardians.
- In the event that I cannot be reached, I heareby give permission to the physician to secure proper treatment for my child/children named in this form.
I Agree Please select this field.

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Growing In Faith Together

Good Shepherd Catholic Community - N.E.T. Catholic

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