Registration Education

Which program(s) will your child(ren) be attending REQUIRED Pastorate Religious Education Program Life Teen Confirmation Special Needs Please fill out this field.

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

Church most frequently attended REQUIRED St. Patrick, Oxford Sacred Heart, Fowler St. Joseph, Kentland Other (please enter below) Please fill out this field.

Other: Please enter valid data.

Home Address REQUIRED Please fill out this field.

Primary Phone REQUIRED Please fill out this field. Please enter valid data.

Primary Email REQUIRED Please fill out this field. Please enter valid data.

Father's Information

Father's Name REQUIRED Please fill out this field. Please enter valid data.
Father's Cell Phone REQUIRED Please fill out this field. Please enter valid data.
Father's Email REQUIRED Please fill out this field. Please enter valid data.
Religion of Father REQUIRED Please fill out this field. Please enter valid data.

Mother's Information

Mother's Name REQUIRED Please fill out this field. Please enter valid data.
Mother's Cell Phone REQUIRED Please fill out this field. Please enter valid data.
Mother's Email REQUIRED Please fill out this field. Please enter valid data.
Religion of Mother REQUIRED Please fill out this field. Please enter valid data.

Children Live with whom REQUIRED Both Parents Mother Father Other (please enter below) Please fill out this field.

Other (please specify) Please enter valid data.

Others authorized to pick-up child(ren)

Name REQUIRED Please fill out this field. Please enter valid data.
Relationship to child(ren) REQUIRED Grandparent Sibling Other Relative (please specify) Family Friend Other Relative (please specify) Please fill out this field.
Relationship to CHILD Other, Please Specify: Please enter valid data.
Address REQUIRED Please fill out this field.
Primary Phone REQUIRED Please fill out this field. Please enter valid data.
Email Address REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Information

Name REQUIRED Please fill out this field. Please enter valid data.
Relationship to Child REQUIRED Grandparent Sibling Aunt/Uncle Other Relative (specify below) Family Friend Please fill out this field.
Other relative (please specify) Please enter valid data.
Address REQUIRED Please fill out this field. Please enter valid data.
Primary Phone REQUIRED Please fill out this field. Please enter valid data.
Email Address REQUIRED Please fill out this field. Please enter valid data.

Medical Insurance

I hereby grant permission for the administration of First Aid to my child(ren) listed below by the people in charge of the Pastorate Religious Education Program , to sign the necessary releases as may be required, and to make the necessary referrals to qualified physicians for the treatment of illness or accidents of a more serious nature. I understand I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In the case of a medical emergency, I understand that every effort will be made to contact the parent/guardian of the participant. In the event that I cannot be reached, I hereby give permission to the physicians selected by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery if deemed necessary for my Insurance child.
Name of Insurance REQUIRED Please fill out this field. Please enter valid data.
Name of Policy Holder REQUIRED Please fill out this field. Please enter valid data.
Policy Number REQUIRED Please fill out this field. Please enter valid data.
Name of Physician REQUIRED Please fill out this field. Please enter valid data.
Physician contact information REQUIRED Please fill out this field. Please enter valid data.

Number of Children to Register REQUIRED Please fill out this field.
Child 1
- Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade Level for 2022-2023 School Year REQUIRED Please fill out this field.
- Sacraments Received (check all that apply) REQUIRED Baptism Reconciliation Holy Communion Confirmation Please fill out this field.
- School Currently Attending REQUIRED Please fill out this field. Please enter valid data.
- Special Educational Considerations Please enter valid data.
- Allergies/Medical Considerations REQUIRED No Yes, please specify Please fill out this field.
- Special Medical Considerations Please enter valid data.
- May we post activity photos of your child? REQUIRED Yes No Please fill out this field.
Child 2
- Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade Level for 2022-2023 School Year REQUIRED Please fill out this field.
- Sacraments Received (check all that apply) REQUIRED Baptism Reconciliation Holy Communion Confirmation Please fill out this field.
- School Currently Attending REQUIRED Please fill out this field. Please enter valid data.
- Special Educational Considerations Please enter valid data.
- Allergies/Medical Considerations REQUIRED No Yes, please specify Please fill out this field.
- Special Medical Considerations Please enter valid data.
- May we post activity photos of your child? REQUIRED Yes No Please fill out this field.
Child 3
- Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade Level for 2022-2023 School Year REQUIRED Please fill out this field.
- Sacraments Received (check all that apply) REQUIRED Baptism Reconciliation Holy Communion Confirmation Please fill out this field.
- School Currently Attending REQUIRED Please fill out this field. Please enter valid data.
- Special Educational Considerations Please enter valid data.
- Allergies/Medical Considerations REQUIRED No Yes, please specify Please fill out this field.
- Special Medical Considerations Please enter valid data.
- May we post activity photos of your child? REQUIRED Yes No Please fill out this field.
Child 4
- Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade Level for 2022-2023 School Year REQUIRED Please fill out this field.
- Sacraments Received (check all that apply) REQUIRED Baptism Reconciliation Holy Communion Confirmation Please fill out this field.
- School Currently Attending REQUIRED Please fill out this field. Please enter valid data.
- Special Educational Considerations Please enter valid data.
- Allergies/Medical Considerations REQUIRED No Yes, please specify Please fill out this field.
- Special Medical Considerations Please enter valid data.
- May we post activity photos of your child? REQUIRED Yes No Please fill out this field.
Child 5
- Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade Level for 2022-2023 School Year REQUIRED Please fill out this field.
- Sacraments Received (check all that apply) REQUIRED Baptism Reconciliation Holy Communion Confirmation Please fill out this field.
- School Currently Attending REQUIRED Please fill out this field. Please enter valid data.
- Special Educational Considerations Please enter valid data.
- Allergies/Medical Considerations REQUIRED No Yes, please specify Please fill out this field.
- Special Medical Considerations Please enter valid data.
- May we post activity photos of your child? REQUIRED Yes No Please fill out this field.
Child 6
- Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade Level for 2022-2023 School Year REQUIRED Please fill out this field.
- Sacraments Received (check all that apply) REQUIRED Baptism Reconciliation Holy Communion Confirmation Please fill out this field.
- School Currently Attending REQUIRED Please fill out this field. Please enter valid data.
- Special Educational Considerations Please enter valid data.
- Allergies/Medical Considerations REQUIRED No Yes, please specify Please fill out this field.
- Special Medical Considerations Please enter valid data.
- May we post activity photos of your child? REQUIRED Yes No Please fill out this field.
Child 7
- Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade Level for 2022-2023 School Year REQUIRED Please fill out this field.
- Sacraments Received (check all that apply) REQUIRED Baptism Reconciliation Holy Communion Confirmation Please fill out this field.
- School Currently Attending REQUIRED Please fill out this field. Please enter valid data.
- Special Educational Considerations Please enter valid data.
- Allergies/Medical Considerations REQUIRED No Yes, please specify Please fill out this field.
- Special Medical Considerations Please enter valid data.
- May we post activity photos of your child? REQUIRED Yes No Please fill out this field.
Child 8
- Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade Level for 2022-2023 School Year REQUIRED Please fill out this field.
- Sacraments Received (check all that apply) REQUIRED Baptism Reconciliation Holy Communion Confirmation Please fill out this field.
- School Currently Attending REQUIRED Please fill out this field. Please enter valid data.
- Special Educational Considerations Please enter valid data.
- Allergies/Medical Considerations REQUIRED No Yes, please specify Please fill out this field.
- Special Medical Considerations Please enter valid data.
- May we post activity photos of your child? REQUIRED Yes No Please fill out this field.

St. Isidore the farmer Pastorate

Fr. SEAN Aaron

Registration Education

Registration for 2023-2024 School Year