St. Genevieve Catholic Church

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Youth Formation Registration/Consent (Grades Pre-K - 9)

- Formation Ministries

(One submission per child enrolled)
The maximum number of form submissions has been reached. This form is currently not available.
- **REGISTRATION STEPS**
  
  1--ONCE YOU SUBMIT THIS COMPLETED FORM FOR EACH CHILD BEING REGISTERED,
  2--USE THE PAYPAL BUTTON BELOW TO MAKE YOUR FEE PAYMENT(S). YOU WILL NEED TO MAKE TWO PAYMENTS ONLY IF YOU HAVE MULTIPLE CHILDREN AND ONE OR MORE IS IN 2ND GRADE.
- Number of children you will be registering? REQUIRED Please fill out this field.
- Registered Church Parish REQUIRED Please fill out this field. Please enter valid data.
- Home Street 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.
- Mailing address if different from above Please enter valid data.
- Father's Full Name (L, F, M) REQUIRED Please fill out this field. Please enter valid data.
- Catholic Yes or No? REQUIRED Please fill out this field.
- Mother's Full Name (L, F, M) REQUIRED Please fill out this field. Please enter valid data.
- Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.
- Catholic Yes or No? REQUIRED Please fill out this field.
- Custodial Guardian(s) Full Name (if diff. from above) Please enter valid data.
- Guardian Mailing Address Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Primary Contact Email REQUIRED Please fill out this field. Please enter an email address.
- Primary Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Father's Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Mother's Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Emergency Phone (if different from above) Maximum 20 characters Please enter a phone number.
- Child's Full Name (L, F, M) REQUIRED Please fill out this field. Please enter valid data.
- Child's Gender REQUIRED Please fill out this field.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter a date.
- City & State of Child's Birth REQUIRED Please fill out this field. Please enter valid data.
- Catholic? REQUIRED Please fill out this field.
- Last CCD Grade or Confirmation Prep. Completed REQUIRED Maximum 3 characters Please fill out this field. Please enter valid data.
- Church Name, City & State if not St. Genevieve Please enter valid data.
- Grade entering this session? REQUIRED Please fill out this field. Please enter valid data.
- Baptized? REQUIRED Please fill out this field.
- Baptism Date Please enter a date.
- Baptism Church Name, City & State Please enter valid data.
- Completed First Reconciliation Requirements? REQUIRED Please fill out this field.
- Reconciliation Church Name, City & State Please enter valid data.
- First Eucharist? REQUIRED Please fill out this field.
- First Eucharist Date Please enter a date.
- Eucharist Church Name, City & State Please enter valid data.
- Special Needs: medical, allergies, learning disabilities, physical disabilities, etc.
- Medical Consent: I authorize a representative of St. Genevieve Church to seek medical attention for my child if I cannot be reached REQUIRED I Agree I Disagree Please fill out this field.
- Photo Consent: I authorize the use of any photos, videos or FaceBook Live video taken of/with my child during youth formation classes or events on all St. Genevieve social media platforms and publications. REQUIRED I Agree I Disagree Please fill out this field.
- Safe Environment Catechesis/Circle of Grace Consent: My child has my permission to attend the Circle of Grace Safe Environment Catechesis/Education sponsored by the Diocese of Houma-Thibodaux and the St. Genevieve Youth Formation Program. REQUIRED I Agree I Agree, but only if I am present for the class(es) I Disagree and will take responsibility to provide the catechesis at home w/the assistance of resources from my parish. Please fill out this field.
- Signature of Parent or Guardian: By my signature (printed name below), I agree that all the information given above is accurate and correct to the best of my ability. REQUIRED Please fill out this field. Please enter valid data.
Submit

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2022-23 PRE K--9 REGISTRATION FEE PAYMENT
(If there is a financial hardship issue for payment of fee(s),
please contact Jessica Harvey @ 985-446-5127 for assistance.)