Our Lady of Perpetual Help Church | Reg. First Communion 2024-2025

Student Name *

First

Middle

Last

Parent's Email - Main Contact *

Address *

Address Line 1

City

State

Zip Code

Date of Birth *

Age *

Gender *

School Grade (as of aug. 2024) *

School Attending *

Is Child Baptized *

YES
NO

1st Communion Class *

Year 1 (click here if this is your child’s first year attending) - $ 150.00
Year 2 (click here if your child attended last year) - $ 250.00

1st Communion classes are for grades 1-8 who have been baptized.

Medical Conditions *

YES
NO

Allergies *

YES
NO

Special Needs *

YES
NO

List any Medical Conditions/Allergies/Special Needs

Name of Parish if student attended last year

PARENT INFORMATION

Father's Name *

Father's Cell Phone *

Father's Religion *

Mother's Name *

Mother's Cell Phone *

Mother's Religion *

EMERGENCY CONTACT INFORMATION

List 2 Persons Other Than Parents

Emergency Contact #1 *

Other Than Parents

City (E1) *

Cell Phone (E1) *

Relationship to Child (E1) *

Emergency Contact #2 *

Other Than Parents

City (E2) *

Cell Phone (E2) *

Relationship to Child (E2) *

Medical Release *

Emergency Acknowledgement

I hereby give permission and consent to have my child(ren) released, in my absence, to any of the two adults listed above in case of an emergency, earthquake or disaster (subject to proper identification). I have notified these two adults of this consent and permission. I hereby permit my son/daughter to participate in all activities pertaining to the Religious Education Program 2022-2023 at Our Lady of Perpetual Help Parish. I hereby release OLPH School/ Parish from any and all liability arising there from. I hereby consent to have my child(ren) receive first aid and/or emergency treatment as determined by paramedic or appropriate school personnel, as the need arises.

Image & Info Release *

Image/visual likeness:
Name:

The Archdiocese/School/Parish intends to use your child’s image and name, for the following non-commercial purposes (describe class/ activity, date(s) if applicable): Photos taken during all RELIGIOUS EDUCATION EVENTS..... http://olphdowney.com/wp-content/uploads/2022/06/2022-2023-Parents-Authorization-to-Use-Childs-Image.pdf

Baptismal Certificate *

Please upload Baptismal Certificate

Total

$ 0.00