CGS Register

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CGS Register

CGS Registration

Fathers Name:

I am interested in being involved in the Atrium:

Yes

No

Fathers Address

Fathers Cell:

Fathers Email

Fathers Religion

Mothers Name

I am interested in being involved in the Atrium:

Yes

No

Mothers Address

Mothers Cell

Mothers Email

Mothers Religion

First Childs Name

First Childs Gender

First Childs Date of Birth

This is my child's first year in the Atrium

Yes

No

First Childs School Attending

Check if your child has received

Baptism

First Communion

Confirmation

First Childs Health Concerns, Allergies, Medications or Other Concerns

New Field:

Second Childs Date of Birth

This is my Childs first year in the Atrium

Yes

No

Second Childs School Attending

Second Childs Check if Received

Baptism

First Communion

Confirmation

Second Childs Health Concerns, Allergies, Medications or Other Concerns

New Field:

Third Childs Gender

Third Childs Date of Birth

This is my child's first year in the Atrium

Yes

No

Third Childs School Attending

Third Childs Check if Received

Baptism

First Communion

Confirmation

Third Childs Health Concerns, Allergies, Medications or Other Concerns

Emergency Contact Name

Emergency Contact Phone

Emergency Contacts Relation to Child

Person with Permission to Pickup Name

Person with Permission to Pickup Phone

Person with Permission to Pickup Relation to Child

Children will only be released to parents, legal guardians, emergency contact, or persons authorized by parent or legal guardian

I understand

I give my permission for my child(ren) (named above) to participate in Saint Raphael the Archangel Catholic Church Atrium. I understand that children will be well supervised, and I will not hold Saint Raphael the Archangel Catholic Church, its employees or volunteers responsible if an accident should occur

I give permission and understand

I give my permission for photos of my family, taken at parish events, including CGS atrium, to be used in parish publications, including newsletters, bulletin, social media, and the website. Names will not be posted

Yes

Thank you for contacting us.
We will get back to you as soon as possible.

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2141 Lancashire Ave. • Louisville, KY 40205

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