Faith Formation Registration 2024/2025

Mom's - Guardian's Information

Mom's First Name Please enter valid data.
Mom's Last Name Please enter valid data.
Mom's Maiden Name Please enter valid data.
Mom's Cell Please enter valid data.

Dad's - Guardian's Information

Dad's First Name Please enter valid data.
Dad's Last Name Please enter valid data.
Dad's Cell Please enter valid data.

Primary Email REQUIRED Please fill out this field. Please enter an email address.

Address

Street REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Primary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

Emergency Contact Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Relationship to Student REQUIRED Please fill out this field. Please enter valid data.

Family Registration Fee35.0

For New First Grade Students ONLY

Place of Baptism (Parish Name and Town) Please enter valid data.

Permission and Waiver Agreement

Please enter your initials REQUIRED Please fill out this field. Please enter valid data.

I hereby give my express permission as parent/legal guardian for my Child[ren] to participate in the Faith Formation Program (“Program”) referenced above. On behalf of my Child[ren] and myself, I fully understand, appreciate, and hereby assume all known and unknown risks related to my Child[ren]’s participation in the Program and voluntarily elect to allow my Child[ren] to participate in the Program. In consideration of the opportunity for my Child[ren] to participate in the Program, I further knowingly and voluntarily on behalf of myself and my Child[ren] do agree to release, hold harmless, and indemnify Blessed Virgin Mary, Queen of Peace Parish (“Parish”) and the Diocese of Scranton (“Diocese”), including their agents, volunteers, and employees, to the fullest extent permitted by law from all liability or claims arising out of my Child[ren]’s participation in the Program in any way. In the case of a health emergency or the need for urgent healthcare, after a reasonable effort has been made to contact me and any emergency contact(s), I authorize and consent to any medical care deemed necessary for my Child[ren]’s health and safety during the Program. If my Child[ren] is/are not covered by hospitalization and medical insurance, I assume responsibility for the cost of hospitalization and medical care for my child.

Please enter your initials Please enter valid data.

I further authorize the Parish and the Diocese to take photographs, video, and audio recordings of my Child[ren] in connection with my Child[ren]’s participation in and promotion of the Faith Formation Program. I acknowledge and agree that photographs, video, or audio of participants in the Program, including my Child[ren], may be used and published for educational and promotional purposes, including, for example, publications, website or social media content, or other print or electronic materials produced from time to time by the Parish or the Diocese. (Participants will not be identified by name, however, without specific written consent.) I agree that if I do not wish my Child[ren] to be photographed, videotaped, or audiotaped, I must notify the Director of Faith Formation in writing.

Please enter your initials REQUIRED Please fill out this field. Please enter valid data.

Finally, I understand that this permission is specifically and only for Faith Formation activities that are hosted on the premises of either or both churches of the Parish (Blessed Virgin Mary, Queen of Peace Church at 314 Chestnut Avenue, Hawley, PA 18428 and St. Veronica’s Church at 122 Shiney Mountain Road, Greentown, PA 18426), and that any and all activities that are offsite will require a separate permission and waiver.

e-Signature Parent/Legal Guardian REQUIRED Please fill out this field. Please enter valid data.

I CERTIFY THAT I AM THE PARENT OR LEGAL GUARDIAN OF THE ABOVE-NAMED CHILD[REN], HAVE READ CONDITIONS STIPULATED HEREIN, AND SIGN IT
VOLUNTARILY.

If registration fees present a financial hardship for your family, please call the Faith Formation office at 570-226-2955 for assistance.

Faith Formation Registration 2024/2025

Online Registration

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