Catechesis of the Good Shepherd Registration

Thank you for trusting us as a partner to assist you with forming your child(ren) in the Catholic faith. As the parent, you are the first and most important educator of your child(ren) and we are grateful for the opportunity to support you. NOTE: YOU MUST FILL OUT THIS FORM SEPARATELY FOR EACH STUDENT.

Student Name*

First Middle Last

Student Birthdate*

Gender*

Has your student participated in CGS before?*

PRIMARY Address of Student*

Street Address City State ZIP Code

Parent(s) name associated with PRIMARY Address*

First Last

SECONDARY Address for Student (if applicable)

Street Address City State ZIP Code

Parent(s) name associated with SECONDARY Address (if applicable)

First Last

Parish where student/family is registered in our Cluster*

BEST number to reach Parent/Guardian*

Name associated with above BEST number*

First Last

ALTERNATE number to reach Parent/Guardian*

Name associated with above ALTERNATE number*

First Last

Father's Name (If parent is not present in child's life, please put N/A in the box)*

First Middle Last

Father's Religion*

Father's email (please enter none@none.com if not applicable)*

Enter Email Confirm Email

Mother's Name (If parent is not present in child's life, please put N/A in the box)*

First Middle Last

Mother's Maiden Name (If parent is not present in child's life, please put N/A in the box)*

Mother's Religion*

Mother's Email (please enter none@none.com if not applicable)

Enter Email Confirm Email

List all special education needs and information we will need to help your student at CGS (be specific)*

If your child does not have any special education needs, please enter N/A in the box.

In the event of an emergency, I give permission to transport my student to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. I further understand that if I cannot be reached, or if the alternate contact that I have listed above cannot be reached, and my student is in need of immediate medical care, the Parish/CGS Leader reserves the right to make a temporary decision that is in the best interest of my student until such a time when I can be reached.*

Yes
No

I give permission for my student to receive minor treatments such as: applying bandages, first-aid ointments or sprays, ice/heat compresses and the like.*

Yes
No

Known allergies and treatment:*

If your child does not have any allergies, please enter N/A in the box.

Image and Recording Release (please click on ADD ENTRY button to complete this section)

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There are no Entries.

Maximum number of entries reached.

Click on Add Entry to select the permissions for Youth Image and Recording release form. You will be able to select either yes or no on the modal popup.

Authorized Person #1 to pick up student*

First Last

Please note that Authorized people will need to provide a photo ID upon picking up your student

Authorized Person #2 to pick up student*

First Last

Draw your signature into the box below.*

Parent/Guardian Signature Name:*

First Last

Date of Parent/Guardian Signature*

Payment Method*

Thank you for signing up your student for Catechesis of the Good Shepherd. Please consider a donation toward our program.

Would you like to cover the Credit Card Fees?