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Date of Last Upload: Friday, September 17, 2021 Student Enrollment Form

  
   New Student Information
Select the Submit Application tab after you have filled in all information including students, primary and secondary family, and emergency/contacts. Use the tab buttons to select the pages to fill in the information. Required fields are bold.


Student 1

*Last Name*First NameMiddle NamePreferred Name*Date of Birth (mm/dd/yyyy)*Grade Level*Indicate Program Preference*Family E-MailHome PhoneSchoolMedical InfoAllergiesI hereby release and indemnify Holy Family Parish, its staff and volunteers and the Catholic Bishop of Chicago, a corporation sole, from any and all liability arising from claims of any kind or nature whatsoever from my child's participation in this yearÆs programs. In the event the undersigned or the noted physician cannot be reached, and in the judgment of a responsible person or appropriate staff member, there is a necessity for immediate examinationand/or treatment of the registered child, I hereby authorize, through my electronic signature below, any of the aforesaid personnel to obtain such medical service. In the signature box below, please provide your first and last name (as the parent/gaurdian of this child) as authorization of the above.*Medical Release SignatureHoly Family staff/volunteers may photograph or videotape my child(ren) during Family and Teen Faith programs/activities to be used in Parish publications and media.