Eastside Family Confirmation Retreat

Parent/Guardian Information

Father

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Mother

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Child(ren) Information REQUIRED Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- My child is a student in St. Cecilia School St. Mary School Family of Faith The St. Cecilia Home School Cooperative Other
- Any medical conditions we should know about? REQUIRED Please fill out this field. Please enter valid data.
- I give permission for my child(ren)'s picture to be taken for such pictures to be used in any promotional materials, in the parish bulletin, on the parish website, or in newspaper articles in relation to this retreat.
- Permission? REQUIRED Yes No Please fill out this field.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- My child is a student in St. Cecilia School St. Mary School Family of Faith The St. Cecilia Home School Cooperative Other
- Any medical conditions we should know about? REQUIRED Please fill out this field. Please enter valid data.
- I give permission for my child(ren)'s picture to be taken for such pictures to be used in any promotional materials, in the parish bulletin, on the parish website, or in newspaper articles in relation to this retreat.
- Permission? REQUIRED Yes No Please fill out this field.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- My child is a student in St. Cecilia School St. Mary School Family of Faith The St. Cecilia Home School Cooperative Other
- Any medical conditions we should know about? REQUIRED Please fill out this field. Please enter valid data.
- I give permission for my child(ren)'s picture to be taken for such pictures to be used in any promotional materials, in the parish bulletin, on the parish website, or in newspaper articles in relation to this retreat.
- Permission? REQUIRED Yes No Please fill out this field.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- My child is a student in St. Cecilia School St. Mary School Family of Faith The St. Cecilia Home School Cooperative Other
- Any medical conditions we should know about? REQUIRED Please fill out this field. Please enter valid data.
- I give permission for my child(ren)'s picture to be taken for such pictures to be used in any promotional materials, in the parish bulletin, on the parish website, or in newspaper articles in relation to this retreat.
- Permission? REQUIRED Yes No Please fill out this field.
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- My child is a student in St. Cecilia School St. Mary School Family of Faith The St. Cecilia Home School Cooperative Other
- Any medical conditions we should know about? REQUIRED Please fill out this field. Please enter valid data.
- I give permission for my child(ren)'s picture to be taken for such pictures to be used in any promotional materials, in the parish bulletin, on the parish website, or in newspaper articles in relation to this retreat.
- Permission? REQUIRED Yes No Please fill out this field.
Child 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- My child is a student in St. Cecilia School St. Mary School Family of Faith The St. Cecilia Home School Cooperative Other
- Any medical conditions we should know about? REQUIRED Please fill out this field. Please enter valid data.
- I give permission for my child(ren)'s picture to be taken for such pictures to be used in any promotional materials, in the parish bulletin, on the parish website, or in newspaper articles in relation to this retreat.
- Permission? REQUIRED Yes No Please fill out this field.
Child 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- My child is a student in St. Cecilia School St. Mary School Family of Faith The St. Cecilia Home School Cooperative Other
- Any medical conditions we should know about? REQUIRED Please fill out this field. Please enter valid data.
- I give permission for my child(ren)'s picture to be taken for such pictures to be used in any promotional materials, in the parish bulletin, on the parish website, or in newspaper articles in relation to this retreat.
- Permission? REQUIRED Yes No Please fill out this field.
Child 8
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- My child is a student in St. Cecilia School St. Mary School Family of Faith The St. Cecilia Home School Cooperative Other
- Any medical conditions we should know about? REQUIRED Please fill out this field. Please enter valid data.
- I give permission for my child(ren)'s picture to be taken for such pictures to be used in any promotional materials, in the parish bulletin, on the parish website, or in newspaper articles in relation to this retreat.
- Permission? REQUIRED Yes No Please fill out this field.