We are asking all registrants to fill out this form. It helps us to ensure we have correct data. Thank you for your understanding! "*" indicates required fields Family Last Name* Parent Name* First Last PhoneEmail* Other Parent Name First Last PhoneEmail Mother's Maiden Name Last Family Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Number of Pre-K-8th Grade Students RegisteringNumber of High School Students Registering** Please note: only a max. of 6 children (Pre K - High School) can be registered on a single form.HiddenTotal Number of KidsStudent #1 InformationStudent Name* First Last Gender Boy Girl Birth Date* MM slash DD slash YYYY Health IssuesAge Group*Pre-KElementaryMiddle SchoolHigh SchoolGrade* Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Grade* 6th Grade 7th Grade 8th Grade Grade* 9th Grade 10th Grade 11th Grade 12th Grade Is your child baptized?* Yes No Baptism Information*Please provide date, church, city and state of Baptism. Baptismal CertificateMax. file size: 300 MB.Please upload a scan or picture of your child's baptismal certificate.I would like Baptism for my child* Yes No Has your child received First Reconciliation & First Communion?* Yes No First Reconciliation & First Communion Information*Please provide date, church, city and state of First Reconciliation & First Communion. I would like First Reconciliation & First Communion for my child* Yes No Has your child been Confirmed?* Yes No Confirmation Information*Please provide date, church, city and state of Confirmation. I would like Confirmation for my child* Yes No Sacrament Prep Needed?Not this yearFirst Reconciliation & First Communion (2nd Grade)Confirmation (7th Grade)Student #2 InformationStudent Name* First Last Gender Boy Girl Birth Date* MM slash DD slash YYYY Health IssuesAge GroupPre-KElementaryMiddle SchoolHigh SchoolGrade* Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Grade* 6th Grade 7th Grade 8th Grade Grade* 9th Grade 10th Grade 11th Grade 12th Grade Is your child baptized?* Yes No Baptism Information*Please provide date, church, city and state of Baptism. Baptismal CertificateMax. file size: 300 MB.Please upload a scan or picture of your child's baptismal certificate.I would like Baptism for my child* Yes No Has your child received First Reconciliation & First Communion?* Yes No First Reconciliation & First Communion Information*Please provide date, church, city and state of First Reconciliation & First Communion. I would like First Reconciliation & First Communion for my child* Yes No Has your child been Confirmed?* Yes No Confirmation Information*Please provide date, church, city and state of Confirmation. I would like Confirmation for my child* Yes No Sacrament Prep Needed This Year?Not this yearFirst Reconciliation & First Communion (2nd Grade)Confirmation (7th Grade)Student #3 InformationStudent Name* First Last Gender Boy Girl Birth Date* MM slash DD slash YYYY Health IssuesAge GroupPre-KElementaryMiddle SchoolHigh SchoolGrade* Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Grade* 6th Grade 7th Grade 8th Grade Grade* 9th Grade 10th Grade 11th Grade 12th Grade Is your child baptized?* Yes No Baptism Information*Please provide date, church, city and state of Baptism. Baptismal CertificateMax. file size: 300 MB.Please upload a scan or picture of your child's baptismal certificate.I would like Baptism for my child* Yes No Has your child received First Reconciliation & First Communion?* Yes No First Reconciliation & First Communion Information*Please provide date, church, city and state of First Reconciliation & First Communion. I would like First Reconciliation & First Communion for my child* Yes No Has your child been Confirmed?* Yes No Confirmation Information*Please provide date, church, city and state of Confirmation. I would like Confirmation for my child* Yes No Sacrament Prep Needed?Not this yearFirst Reconciliation & First Communion (2nd Grade)Confirmation (7th Grade)Student #4 InformationStudent Name* First Last Gender Boy Girl Birth Date* MM slash DD slash YYYY Health IssuesAge GroupPre-KElementaryMiddle SchoolHigh SchoolGrade* Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Grade* 6th Grade 7th Grade 8th Grade Grade* 9th Grade 10th Grade 11th Grade 12th Grade Is your child baptized?* Yes No Baptism Information*Please provide date, church, city and state of Baptism. Baptismal CertificateMax. file size: 300 MB.Please upload a scan or picture of your child's baptismal certificate.I would like Baptism for my child* Yes No Has your child received First Reconciliation & First Communion?* Yes No First Reconciliation & First Communion Information*Please provide date, church, city and state of First Reconciliation & First Communion. I would like First Reconciliation & First Communion for my child* Yes No Has your child been Confirmed?* Yes No Confirmation Information*Please provide date, church, city and state of Confirmation. I would like Confirmation for my child* Yes No Sacrament Prep Needed?Not this yearFirst Reconciliation & First Communion (2nd Grade)Confirmation (7th Grade)Student #5 InformationStudent Name* First Last Gender Boy Girl Birth Date* MM slash DD slash YYYY Health IssuesAge GroupPre-KElementaryMiddle SchoolHigh SchoolGrade* Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Grade* 6th Grade 7th Grade 8th Grade Grade* 9th Grade 10th Grade 11th Grade 12th Grade Is your child baptized?* Yes No Baptism Information*Please provide date, church, city and state of Baptism. Baptismal CertificateMax. file size: 300 MB.Please upload a scan or picture of your child's baptismal certificate.I would like Baptism for my child* Yes No Has your child received First Reconciliation & First Communion?* Yes No First Reconciliation & First Communion Information*Please provide date, church, city and state of First Reconciliation & First Communion. I would like First Reconciliation & First Communion for my child* Yes No Has your child been Confirmed?* Yes No Confirmation Information*Please provide date, church, city and state of Confirmation. I would like Confirmation for my child* Yes No Sacrament Prep Needed?Not this yearFirst Reconciliation & First Communion (2nd Grade)Confirmation (7th Grade)Student #6 InformationStudent Name* First Last Gender Boy Girl Birth Date* MM slash DD slash YYYY Health IssuesAge GroupElementaryMiddle SchoolHigh SchoolPre-KGrade* Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Grade* 6th Grade 7th Grade 8th Grade Grade* 9th Grade 10th Grade 11th Grade 12th Grade Is your child baptized?* Yes No Baptism Information*Please provide date, church, city and state of Baptism. Baptismal CertificateMax. file size: 300 MB.Please upload a scan or picture of your child's baptismal certificate.I would like Baptism for my child* Yes No Has your child received First Reconciliation & First Communion?* Yes No First Reconciliation & First Communion Information*Please provide date, church, city and state of First Reconciliation & First Communion. I would like First Reconciliation & First Communion for my child* Yes No Has your child been Confirmed?* Yes No Confirmation Information*Please provide date, church, city and state of Confirmation. I would like Confirmation for my child* Yes No Sacrament Prep Needed?Not this yearFirst Reconciliation & First Communion (2nd Grade)Confirmation (7th Grade)Emergency ContactName First Last PhoneRelationship Photography Waiver By checking this box I grant permission to use my child’s (children's)/youth name, likeness and/or photographic image in the production of brochures, newsletters, websites, newspapers, etc. I grant permission to use my child’s (children's)/youth name, likeness and/or photographic image in the production of brochures, newsletters, websites, newspapers, etc.Novel Coronavirus Acknowledgement & Waiver* By checking this box and writing my name below I understand and will adhere to the conditions belowI agree, represent and warrant that neither the undersigned, nor any registered participant child(ren) shall visit or participate in the activities of the Diocese of Cheyenne at any parish within 14 days after (1) returning from outside the United States, (2) exposure to any person returning from outside the United States, or (3) exposure to any person who has a suspected or confirmed case of COVID-19; OR if he or she (1) experiences symptoms of COVID-19, including without limitation, fever, cough or shortness of breath, or (2) has a suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify the Program Administrator (or their immediate assistant) immediately if any of the foregoing access/use restrictions may apply. The Diocese of Cheyenne and the participating diocesan parishes have or may put in place preventative measures to reduce the spread of COVID-19 before and during all faith formation, religious education, catechetical activities and events, youth ministry, and young adult ministry (“faith formation”). I agree to comply with measures that may be required to best protect against the introduction of viruses at the parishes, including, but not limited to hygiene practices and temperature screening, completion of a daily screening form, social distancing, and the use of personal protective equipment such as masks and/or gloves. However, the Diocese of Cheyenne or its participating parishes cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending faith formation may or may not increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I could possibly be exposed to or infected by COVID-19, by participating in faith formation, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at faith formation at parishes may result from the actions, omissions, or negligence of myself and others, including but not limited to, employees and volunteers of the Diocese of Cheyenne or participating parishes, in addition to other program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself, including but not limited to, personal injury, disability, death, illness, damage, loss, claim, liability or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at faith formation. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge and hold harmless Bishop Steven Biegler, the Diocese of Cheyenne, all participating Catholic diocesan parishes and their employees, volunteers, agents, and representatives of and from any and all claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of any of the foregoing persons or entities, its employees, volunteers, agents, and representatives, whether a COVID-19 infection occurs before, during or after participation in any faith formation activity. I have read and will adhere to the Corona Virus Acknowledgement and Waiver* First Last Classroom Volunteer Opportunities Teacher Teacher's Aide Substitute Teacher Please Note: Background Check and Safe Environment Training NeededCAPTCHATotal CostThis year's religious education cost (Pre-K - 8th) is $15.00 per child. There is no cost for Youth Ministry (high school). A link to pay will appear on the next page after you submit your registration form. Once you submit your form, there will be a link to make your payment. Total Cost for K-8th GradeCommentsThis field is for validation purposes and should be left unchanged.
