Date of Registration*
MM slash DD slash YYYY
Mother's Name*
First
Middle
Last
Mobile Phone*
Primary Address*
Primary Email*
Father's Name*
First
Middle
Last
Mobile Phone*
Personal Email*
Address (if different than above)
Child's Information How many children are you registering for faith formation?* 0 1 2 3 4 5 6
Name of Child #1*
First
Middle
Last
Which program are you registering for? (Please check all that apply)* Gender* Male Female
Date of Birth*
MM slash DD slash YYYY
School Attending in 2024-2025*
Grade in 2024-2025*
Sacramental Information (Please check all that have been completed)* Parish of Baptism and Date*
Upload Baptismal Certificate 1st Grade Religious Education* Prior Year Religious Education* Permission to Contact Youth* I hereby grant permission for Mary Our Queen to contact my child, for internal or external communications until May 31,2023 via social media, email, text, and/or parish/school-approved online/virtual platforms. I understand I can request the same communications provided to my child, and that it does not have to be via the same technology (for example, if children receive a reminder via Twitter, parents can receive it in a printed form or by an email list).
I grant this permission
Student Email*
Student Cell*
Emergency Medical Release* I/We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone, also the Archdiocese and its representatives, successors,
I consent to the emergency medical release
Does your child have any allergies or health concerns that we need to know about?*
Is your child taking any medication? Please list below*
Does your child have any drug allergies? Please list below*
I hereby grant permission for non prescription medication to be given, if deemed appropriate* Media Policy* Mary Our Queen uses images, interviews, and videos of our children for a variety of internal and external communications. Our forms of internal and external communications include but are not limited to: print, such as newspapers, bulletins, and newsletters; photographs and digital images; film and videos; web posts, web pages, and image carousels.
I agree to the media policy.
Protecting God's Children* The Archdiocese of Atlanta subscribes to VIRTUS® to provide a consistent Safe Environment foundation for our children. It is the shared responsibility of parents, teachers, and catechists to give our children the awareness and tools they need to overcome anyone who intends to harm them. It is an expectation that all Catholic Schools and Faith Formation programs use the VIRTUS® Lesson plan. I give my permission for my child(ren) to attend the Archdiocesan VIRTUS Program.
I give permission for my child to attend the Archdiocesan VIRTUS Program
Name of Child #2*
First
Middle
Last
Which program are you registering for? (Please check all that apply)* Gender* Male Female
Date of Birth*
MM slash DD slash YYYY
School Attending in 2024-2025*
Grade in 2024-2025*
Sacramental Information (Please check all that have been completed)* Parish of Baptism and Date*
Upload Baptismal Certificate 1st Grade Religious Education* Prior Year Religious Education Permission to Contact Youth* I hereby grant permission for Mary Our Queen to contact my child, for internal or external communications until May 31,2023 via social media, email, text, and/or parish/school-approved online/virtual platforms. I understand I can request the same communications provided to my child, and that it does not have to be via the same technology (for example, if children receive a reminder via Twitter, parents can receive it in a printed form or by an email list).
I grant this permission
Student Email*
Student Cell*
Emergency Medical Release* I/We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone, also the Archdiocese and its representatives, successors,
I consent to the emergency medical release
Does your child have any allergies or health concerns that we need to know about?*
Is your child taking any medication? Please list below*
Does your child have any drug allergies? Please list below*
I hereby grant permission for non prescription medication to be given, if deemed appropriate* Media Policy* Mary Our Queen uses images, interviews, and videos of our children for a variety of internal and external communications. Our forms of internal and external communications include but are not limited to: print, such as newspapers, bulletins, and newsletters; photographs and digital images; film and videos; web posts, web pages, and image carousels.
I agree to the media policy.
Protecting God's Children* The Archdiocese of Atlanta subscribes to VIRTUS® to provide a consistent Safe Environment foundation for our children. It is the shared responsibility of parents, teachers, and catechists to give our children the awareness and tools they need to overcome anyone who intends to harm them. It is an expectation that all Catholic Schools and Faith Formation programs use the VIRTUS® Lesson plan. I give my permission for my child(ren) to attend the Archdiocesan VIRTUS Program.
I give permission for my child to attend the Archdiocesan VIRTUS Program
Name of Child #3*
First
Middle
Last
Which program are you registering for? (Please check all that apply)* Gender* Male Female
Date of Birth*
MM slash DD slash YYYY
School Attending in 2024-2025*
Grade in 2024-2025*
Sacramental Information (Please check all that have been completed)* Parish of Baptism and Date*
Upload Baptismal Certificate 1st Grade Religious Education* Prior Year Religious Education* Permission to Contact Youth* I hereby grant permission for Mary Our Queen to contact my child, for internal or external communications until May 31,2023 via social media, email, text, and/or parish/school-approved online/virtual platforms. I understand I can request the same communications provided to my child, and that it does not have to be via the same technology (for example, if children receive a reminder via Twitter, parents can receive it in a printed form or by an email list).
I grant this permission
Student Email*
Student Cell*
Emergency Medical Release* I/We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone, also the Archdiocese and its representatives, successors,
I consent to the emergency medical release
Does your child have any allergies or health concerns that we need to know about?*
Is your child taking any medication? Please list below*
Does your child have any drug allergies? Please list below*
I hereby grant permission for non prescription medication to be given, if deemed appropriate* Media Policy* Mary Our Queen uses images, interviews, and videos of our children for a variety of internal and external communications. Our forms of internal and external communications include but are not limited to: print, such as newspapers, bulletins, and newsletters; photographs and digital images; film and videos; web posts, web pages, and image carousels.
I agree to the media policy.
Protecting God's Children* The Archdiocese of Atlanta subscribes to VIRTUS® to provide a consistent Safe Environment foundation for our children. It is the shared responsibility of parents, teachers, and catechists to give our children the awareness and tools they need to overcome anyone who intends to harm them. It is an expectation that all Catholic Schools and Faith Formation programs use the VIRTUS® Lesson plan.
I give permission for my child to attend the Archdiocesan VIRTUS Program
Name of Child #4*
First
Middle
Last
Which program are you registering for? (Please check all that apply)* Gender* Male Female
Date of Birth*
MM slash DD slash YYYY
School Attending in 2024-2025*
Grade in 2024-2025*
Sacramental Information (Please check all that have been completed)* Parish of Baptism and Date*
Upload Baptismal Certificate 1st Grade Religious Education* Prior Year Religious Education* Permission to Contact Youth* I hereby grant permission for Mary Our Queen to contact my child, for internal or external communications until May 31,2023 via social media, email, text, and/or parish/school-approved online/virtual platforms. I understand I can request the same communications provided to my child, and that it does not have to be via the same technology (for example, if children receive a reminder via Twitter, parents can receive it in a printed form or by an email list).
I grant this permission
Student Email*
Student Cell*
Emergency Medical Release* I/We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone, also the Archdiocese and its representatives, successors,
I consent to the emergency medical release
Does your child have any allergies or health concerns that we need to know about?*
Is your child taking any medication? Please list below*
Does your child have any drug allergies? Please list below*
I hereby grant permission for non prescription medication to be given, if deemed appropriate* Media Policy* Mary Our Queen uses images, interviews, and videos of our children for a variety of internal and external communications. Our forms of internal and external communications include but are not limited to: print, such as newspapers, bulletins, and newsletters; photographs and digital images; film and videos; web posts, web pages, and image carousels.
I agree to the media policy.
Protecting God's Children* The Archdiocese of Atlanta subscribes to VIRTUS® to provide a consistent Safe Environment foundation for our children. It is the shared responsibility of parents, teachers, and catechists to give our children the awareness and tools they need to overcome anyone who intends to harm them. It is an expectation that all Catholic Schools and Faith Formation programs use the VIRTUS® Lesson plan.
I give permission for my child to attend the Archdiocesan VIRTUS Program
Name of Child #5*
First
Middle
Last
Which program are you registering for? (Please check all that apply)* Gender* Male Female
Date of Birth*
MM slash DD slash YYYY
School Attending in 2024-2025*
Grade in 2024-2025*
Sacramental Information (Please check all that have been completed)* Parish of Baptism and Date*
Upload Baptismal Certificate 1st Grade Religious Education* Prior Year Religious Education* Permission to Contact Youth* I hereby grant permission for Mary Our Queen to contact my child, for internal or external communications until May 31,2023 via social media, email, text, and/or parish/school-approved online/virtual platforms. I understand I can request the same communications provided to my child, and that it does not have to be via the same technology (for example, if children receive a reminder via Twitter, parents can receive it in a printed form or by an email list).
I grant this permission
Student Email*
Student Cell*
Emergency Medical Release* I/We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone, also the Archdiocese and its representatives, successors,
I consent to the emergency medical release
Does your child have any allergies or health concerns that we need to know about?*
Is your child taking an medication? Please list below*
Does your child have any drug allergies? Please list below*
I hereby grant permission for non prescription medication to be given, if deemed appropriate* Media Policy* Mary Our Queen uses images, interviews, and videos of our children for a variety of internal and external communications. Our forms of internal and external communications include but are not limited to: print, such as newspapers, bulletins, and newsletters; photographs and digital images; film and videos; web posts, web pages, and image carousels.
I agree to the media policy.
Protecting God's Children* The Archdiocese of Atlanta subscribes to VIRTUS® to provide a consistent Safe Environment foundation for our children. It is the shared responsibility of parents, teachers, and catechists to give our children the awareness and tools they need to overcome anyone who intends to harm them. It is an expectation that all Catholic Schools and Faith Formation programs use the VIRTUS® Lesson plan.
I give permission for my child to attend the Archdiocesan VIRTUS Program
Name of Child #6*
First
Middle
Last
Which program are you registering for? (Please check all that apply)* Gender* Male Female
Date of Birth*
MM slash DD slash YYYY
School Attending in 2024-2025*
Grade in 2024-2025*
Sacramental Information (Please check all that have been completed)* Parish of Baptism and Date*
Permission to Contact Youth* I hereby grant permission for Mary Our Queen to contact my child, for internal or external communications until May 31,2023 via social media, email, text, and/or parish/school-approved online/virtual platforms. I understand I can request the same communications provided to my child, and that it does not have to be via the same technology (for example, if children receive a reminder via Twitter, parents can receive it in a printed form or by an email list).
I grant this permission
Student Email*
Student Cell*
Emergency Medical Release* I/We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone, also the Archdiocese and its representatives, successors,
I consent to the emergency medical release
Does your child have any allergies or health concerns that we need to know about?*
Is your child taking an medication? Please list below*
Does your child have any drug allergies? Please list below*
I hereby grant permission for non prescription medication to be given, if deemed appropriate* Media Policy* Mary Our Queen uses images, interviews, and videos of our children for a variety of internal and external communications. Our forms of internal and external communications include but are not limited to: print, such as newspapers, bulletins, and newsletters; photographs and digital images; film and videos; web posts, web pages, and image carousels.
I agree to the media policy.
Protecting God's Children* The Archdiocese of Atlanta subscribes to VIRTUS® to provide a consistent Safe Environment foundation for our children. It is the shared responsibility of parents, teachers, and catechists to give our children the awareness and tools they need to overcome anyone who intends to harm them. It is an expectation that all Catholic Schools and Faith Formation programs use the VIRTUS® Lesson plan.
I give permission for my child to attend the Archdiocesan VIRTUS Program
Emergency Contact Name*
First
Last
Relationship*
(neighbor, friend, grandparent, etc.)
Emergency Contact's Phone Number*
Insurance Information Insurance Carrier
Name on Policy
Relationship to Participant
Policy Number
Group Number
CAPTCHA
Parent Signature* I have read and understand all consents for each child I wish to register.
