Life Plus Opt/Out & Religious Education Registration Form

The Diocese of Orlando has implemented a child abuse awareness, prevention, and safety program in all parishes and Catholic schools as mandated by the United States Conference of Catholic Bishops (USCCB) in compliance with the Charter for the Protection of Children and Young People. Students enrolled in a Catholic School or parish-based catechesis are encouraged to participate in this programming. Our diocese is required, through an audit process, to verify to the USCCB that this training has been provided. We are also required to keep track of the number of students who are absent or whose parents do not allow them to participate in the training. Please make your selection below and provide electronic signature. Thank you.
Name of Child or Children(*)
Please let us know your child or children's names.

Name of Schools or Parish(*)
Please let us know the name of your school or parish.

City of Schools or Parish(*)
Please let us know the city of your school or parish.

Child/Children's Grade Levels(*)
Please let us know your children(s) grade level(s).

Name of Parent(s) or Guardian(s)(*)
Invalid Input

Relationship(*)
Invalid Input

Reason for Opting-Out (Optional)
Please let us know your message.

I am Opting-Out for my Child/Children(*)
Invalid Input

Parent/Legal Guardian Electronic Signature ( type your name here)(*)
Invalid Input

 
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RELIGIOUS EDUCATION REGISTRATION FORM
Family Information (New parishioners, please submit a Parish Registration Form also.)
Family Name(*)
Please enter your last name.

Address(*)
Please enter your street address.

City(*)
Please enter your home city.

State(*)
Please enter your home state.

Zip Code(*)
Please enter your home Zip Code.

Home Phone(*)
Please enter your home phone.

Cell Phone(*)
Please enter your cell phone.

E-mail(*)
Invalid email address.

Unlisted?(*)
Is phone listed or unlisted?

Parent/Guardian Information
Parent/Guardian Name 1(*)
Please enter parent/guardian name.

Relationship to Child(*)
Please enter relationship with child.

Phone(*)
Please enter phone number.

Religion(*)
Please enter religion.

Marital Status(*)
Please enter marital status.

Parent/Guardian Name 2
Invalid Input

Relationship to Child
Invalid Input

Phone
Invalid Input

Religion

Marital Status
Invalid Input

Parent/Legal Guardian Electronic Signature ( type your name here)(*)
Please enter your signature.

Additional Family Information
Student(s) Lives With(*)
Where does student live.

If Other, who:

What is the primary language spoken in the home?

In the event of an EMERGENCY, if you are unable to reach me, please contact the following:
Name

Address
Please enter your street address.

City
Please enter your home city.

Phone
Please enter your home phone.

Cell Phone
Please enter your home phone.

Relationship

Number of students from family being registered
Invalid Input

 
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Student #1 Information (start with youngest to oldest)
First Name(*)
Please enter child's first name.

Grade this year(*)
Please enter child's grade this year.

School(*)
Please enter child's school.

Religion(*)
Please enter child's religion.

Language(*)
Please enter language.

Birthday (MM/DD/YY)(*)
Please enter the birth date.

Sex(*)
Please enter sex.

Attended here before?(*)
Please enter if child has attended here before.

Health Problems/Other Conditions
Invalid Input

Please choose class and time:(*)

Invalid Input

Baptism (date, name & address of church)
Please enter baptism date.

Reconciliation (date, name & address of church)
Please enter First Reconciliation date.

1st Communion (date, name & address of church)
Please enter 1st Communion information.

Confirmation (date, name and address of church)
Invalid Input

Student #2 Information
First Name
Invalid Input

Grade this year
Invalid Input

School
Invalid Input

Religion
Invalid Input

Language
Invalid Input

Birthday (MM/DD/YY)
Please enter the month of your date of birth.

Sex
Invalid Input

Attended here before?
Invalid Input

Health Problems/Other Conditions
Invalid Input

Please choose class and time:

Invalid Input

Baptism (date, name & address of church)
Invalid Input

Reconciliation (date, name & address of church)
Invalid Input

1st Communion (date, name & address of church)
Invalid Input

Confirmation (date, name and address of church)
Invalid Input

Student #3 Information
First Name
Invalid Input

Grade this year
Invalid Input

School
Invalid Input

Religion
Invalid Input

Language
Invalid Input

Birthday (MM/DD/YY)
Please enter the month of your date of birth.

Sex
Invalid Input

Attended here before?
Invalid Input

Health Problems/Other Conditions
Invalid Input

Please choose class and time:

Invalid Input

Baptism (date, name & address of church)
Invalid Input

Reconciliation (date, name & address of church)
Invalid Input

1st Communion (date, name & address of church)
Invalid Input

Confirmation (date, name and address of church)
Invalid Input

 
Page 4 of 4
Student #4 Information
First Name
Invalid Input

Grade this year
Invalid Input

School
Invalid Input

Religion
Invalid Input

Ethnic Background
Invalid Input

Language
Invalid Input

Birthday (MM/DD/YY)
Please enter the month of your date of birth.

Sex
Invalid Input

Attended here before?
Invalid Input

Health Problems/Other Conditions
Invalid Input

Please choose class and time:

Invalid Input

Baptism (date, name & address of church)
Invalid Input

Reconciliation (date, name & address of church)
Invalid Input

1st Communion (date, name & address of church)
Invalid Input

Confirmation (date, name and address of church)
Invalid Input

Student #5 Information
First Name
Invalid Input

Attended here before?
Invalid Input

Grade this year
Invalid Input

School
Invalid Input

Religion
Invalid Input

Ethnic Background
Invalid Input

Language
Invalid Input

Birthday (MM/DD/YY)
Please enter the month of your date of birth.

Sex
Invalid Input

Health Problems/Other Conditions
Invalid Input

Please choose class and time:

Invalid Input

Baptism (date, name & address of church)
Invalid Input

Reconciliation (date, name & address of church)
Invalid Input

1st Communion (date, name & address of church)
Invalid Input

Confirmation (date, name and address of church)
Invalid Input

Registration Fee(*)
Please select the number of students you are registering.

Total:
0.00 USD

Invalid Input