Catechesis of the Good Shepherd Registration

Student 1

Level *1 (Ages 3-5)2 (Ages 6-9)

Name *

New to AtriumYesNo

Pronouns *FemaleMale

Date of Birth

PreschoolYesNo

Information regarding child's medical or special needs that we should consider:

Photo Release *This release is for any and all programs sponsored by Blessed Trinity Parish. I Photographs or videos may be made that include this child nd the use of such photographs or videotapes and/or stories in connection with any work of Blessed Trinity Parish including, but not limited to publications, social media and websites without consideration of any kind. I do hereby release Blessed Trinity Parish from any claims whatsoever which may arise in said regard.I consent to the photo release.I do not consent to the photo release.

Student 2

Level1 (Ages 3-5)2 (Ages 6-9)

Name

New to AtriumYesNo

PronounsFemaleMale

Date of Birth

PreschoolYesNo

Information regarding child's medical or special needs that we should consider:

Photo ReleaseThis release is for any and all programs sponsored by Blessed Trinity Parish. I Photographs or videos may be made that include this child nd the use of such photographs or videotapes and/or stories in connection with any work of Blessed Trinity Parish including, but not limited to publications, social media and websites without consideration of any kind. I do hereby release Blessed Trinity Parish from any claims whatsoever which may arise in said regard.I consent to the photo release.I do not consent to the photo release.

Student 3

Level1 (Ages 3-5)2 (Ages 6-9)

Name

New to AtriumYesNo

PronounsFemaleMale

Date of Birth

PreschoolYesNo

Information regarding child's medical or special needs that we should consider:

Parent/Guardian Information

Name *

Relationship to Child *

Email Address *

Preferred Phone *

Secondary Phone

Best time to reach you

Hours

Minutes

AM/PM

Church Member at: *

Parent/Guardian Address

Apartment, suite, etc

City

State/Province

ZIP / Postal code

In case of an emergency, if I cannot be reached, please contact:

Name *

Relationship to Child *

Preferred Phone *

Secondary Phone

Consent *

In submitting this form, I authorize the participation of the named child(ren) in the Catechesis of the Good Shepherd program at Blessed Trinity Parish for the 2026-2027.