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OLOP Youth Formation Registration 2020-2021 online form

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- Registration Fee: $25.00 per child with a $10.00 Sacramental Fee for grades 2nd & 11th
- Student Information
  
  Student Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter valid data.
  
  School Child is attending: REQUIRED Please fill out this field. Please enter valid data.
  
  Grade level in school: REQUIRED Please fill out this field. Please enter valid data.
  
  Grade level in CCD: REQUIRED Please fill out this field. Please enter valid data.
  
  Siblings (if any) & Grade:
  
  Student Activities that may interfere with Religious Ed REQUIRED Please fill out this field.
  
  I give permission to OLOP/YF to add my child’s cell phone to “REMIND” for all future communications in regards to classes, church events, and/or Diocese events. REQUIRED I Agree I Disagree Please fill out this field.
  
  Student's Cell Number: Please enter valid data.
- Contact Information
  
  Parent(s) or Guardian(s): REQUIRED Please fill out this field. Please enter valid data.
  
  Mailing Address: REQUIRED Please fill out this field.
  
  Primary Contact Cell Phone: REQUIRED Please fill out this field. Please enter valid data.
  
  Secondary Contact Phone: Please enter valid data.
  
  Primary Contact E-mail address: REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Child: REQUIRED Please fill out this field. Please enter valid data.
- Medications:
  
  Student Allergies or Health Issues (if none, type None in the box): REQUIRED Please fill out this field.
  
  List of Medications (if none type none in the box): REQUIRED Please fill out this field.
  
  Epi-pen Needed
  
  Inhaler Needed:
  
  Will Child Bring to Class:
  
  Does your child have an IEP or Learning Disabilities? REQUIRED Please fill out this field.
- Divorced/Separated Parents
  
  If information is different from above
  
  Father's Name: Please enter valid data.
  
  Father's Cell Number: Please enter valid data.
  
  Father's Address:
  
  Mother's Name: Please enter valid data.
  
  Mother's Cell Number: Please enter valid data.
  
  Mother's Address:
- Church Information
  
  Baptism Date/Church: Please enter valid data.
  
  Penance Date/Church: Please enter valid data.
  
  Communion Date/Church: Please enter valid data.
  
  Has your child attended another Religious Ed. before? REQUIRED Please fill out this field.
  
  If Yes, When? Please enter valid data.
  
  If Yes, Where? Please enter valid data.
  
  If Yes, Grade Completed? Please enter valid data.
- I, give permission for OLOP/YF to post pictures of my child on OLOP Facebook and/or Instagram to share with church congregation, family and friends of special events held within our Church Parish involving ministry REQUIRED I Agree I Disagree Please fill out this field.
- Signature (Please type full name) REQUIRED Please fill out this field. Please enter valid data.
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Our Lady of Prompt Succor Catholic Church

Golden Meadow, LA

OLOP Youth Formation Registration 2020-2021 online form