First Eucharist 2022 Registration Form

Please complete the registration form below to register your child(ren) for our 2022 First Eucharist program.

*You can register two children on this form.

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Father's Name Please enter valid data.

Mother's Name (Including Maiden Name) Please enter valid data.

Street Address 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.

Phone Number (Home) Please enter a phone number.

Dad's Cell Phone Number Please enter a phone number.

Mom's Cell Phone Number Please enter a phone number.

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

How many children would you like to register for First Eucharist 2022? REQUIRED Please fill out this field.
Name of First Communicant 1
- Name (LAST, First & Middle) REQUIRED Please fill out this field. Please enter valid data.
- Child's Nickname (skip if this does not apply) Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade REQUIRED Please fill out this field. Please enter an integer (number).
- Church of Baptism Name, City & State REQUIRED Please fill out this field. Please enter valid data.
- Please indicate the Faith Formation session your child is attending/attended at Good Shepherd. REQUIRED Tuesday at 4:45 p.m. Wednesday at 5:15 p.m. Summer Faith Formation Other (please phone Nancy Dallas to discuss) Please fill out this field.
- FIRST EUCHARIST SESSION: Please select the session (there are three options) you would like your child to attend, along with the selected workshop ( Note: Sessions II and III have multiple workshop options listed).
- SESSION I:
  Celebration- Sun., Feb. 20, 2022 (2 p.m.)
  WORKSHOP - Sat., Feb. 5, 2022 (9 a.m.-Noon)
  Retreat - Sat., Feb. 12, 2022 (9:30 am.-Noon)
  Practice - Sat., Feb. 19, 2022 (8:30-9:15 a.m.)
- I would like my child to attend: Session I - Workshop takes place on Sat., Feb. 5, 2022
- SESSION II
  Celebration - Sun., April 24, 2022 (2 p.m.)
  WORKSHOP - Sat., Feb. 5, 2022 (9 a.m.-Noon)
  WORKSHOP - Sat., April 2, 2022 (9 a.m.-Noon)
  Retreat - Sat., April 9, 2022 (9:30 am.-Noon)
  Practice - Sat., April 23, 2022 (8:30-9:15 a.m.)
- I would like my child to attend (select one): Session II & attend the workshop on
  Sat., Feb. 5, 2022 Session II & attend the workshop on
  Sat., April 2, 2022
- SESSION III
  Celebration - Sun., May 22, 2022 (2 p.m.)
  WORKSHOP - Sat., Feb. 5, 2022 (9 a.m.-Noon)
  WORKSHOP - Sat., April 2, 2022 (9 a.m.-Noon)
  WORKSHOP - Sat., May 7, 2022 (9 a.m.-Noon)
  Retreat - Sat., May 14, 2022 (9:30 am.-Noon)
  Practice - Sat., May 21, 2022 (8:30-9:15 a.m.)
- I would like my child to attend (select one): Session III & attend the workshop on
  Sat., Feb. 5, 2022 Session III & attend the workshop on
  Sat., April 2, 2022 Session III & attend the workshop on
  Sat., May 7, 2022
- MEDICAL INFORMATION
- Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- FAMILY DOCTOR
- What is the name of your family doctor? REQUIRED Please fill out this field. Please enter valid data.
- Phone number for your family doctor. REQUIRED Please fill out this field. Please enter valid data.
Name of First Communicant 2
- Name (LAST, First & Middle) REQUIRED Please fill out this field. Please enter valid data.
- Child's Nickname (skip if this does not apply) Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade REQUIRED Please fill out this field. Please enter an integer (number).
- Church of Baptism Name, City & State REQUIRED Please fill out this field. Please enter valid data.
- Please indicate the Faith Formation session your child is attending/attended at Good Shepherd. REQUIRED Tuesday at 4:45 p.m. Wednesday at 5:15 p.m. Summer Faith Formation Other (please phone Nancy Dallas to discuss) Please fill out this field.
- FIRST EUCHARIST SESSION: Please select the session (there are three options) you would like your child to attend, along with the selected workshop ( Note: Sessions II and III have multiple workshop options listed).
- SESSION I:
  Celebration- Sun., Feb. 20, 2022 (2 p.m.)
  WORKSHOP - Sat., Feb. 5, 2022 (9 a.m.-Noon)
  Retreat - Sat., Feb. 12, 2022 (9:30 am.-Noon)
  Practice - Sat., Feb. 19, 2022 (8:30-9:15 a.m.)
- I would like my child to attend: Session I - Workshop takes place on Sat., Feb. 5, 2022
- SESSION II
  Celebration - Sun., April 24, 2022 (2 p.m.)
  WORKSHOP - Sat., Feb. 5, 2022 (9 a.m.-Noon)
  WORKSHOP - Sat., April 2, 2022 (9 a.m.-Noon)
  Retreat - Sat., April 9, 2022 (9:30 am.-Noon)
  Practice - Sat., April 23, 2022 (8:30-9:15 a.m.)
- I would like my child to attend (select one): Session II & attend the workshop on
  Sat., Feb. 5, 2022 Session II & attend the workshop on
  Sat., April 2, 2022
- SESSION III
  Celebration - Sun., May 22, 2022 (2 p.m.)
  WORKSHOP - Sat., Feb. 5, 2022 (9 a.m.-Noon)
  WORKSHOP - Sat., April 2, 2022 (9 a.m.-Noon)
  WORKSHOP - Sat., May 7, 2022 (9 a.m.-Noon)
  Retreat - Sat., May 14, 2022 (9:30 am.-Noon)
  Practice - Sat., May 21, 2022 (8:30-9:15 a.m.)
- I would like my child to attend (select one): Session III & attend the workshop on
  Sat., Feb. 5, 2022 Session III & attend the workshop on
  Sat., April 2, 2022 Session III & attend the workshop on
  Sat., May 7, 2022
- MEDICAL INFORMATION
- Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- FAMILY DOCTOR
- What is the name of your family doctor? REQUIRED Please fill out this field. Please enter valid data.
- Phone number for your family doctor. REQUIRED Please fill out this field. Please enter valid data.
Name of First Communicant 3
- Name (LAST, First & Middle) REQUIRED Please fill out this field. Please enter valid data.
- Child's Nickname (skip if this does not apply) Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade REQUIRED Please fill out this field. Please enter an integer (number).
- Church of Baptism Name, City & State REQUIRED Please fill out this field. Please enter valid data.
- Please indicate the Faith Formation session your child is attending/attended at Good Shepherd. REQUIRED Tuesday at 4:45 p.m. Wednesday at 5:15 p.m. Summer Faith Formation Other (please phone Nancy Dallas to discuss) Please fill out this field.
- FIRST EUCHARIST SESSION: Please select the session (there are three options) you would like your child to attend, along with the selected workshop ( Note: Sessions II and III have multiple workshop options listed).
- SESSION I:
  Celebration- Sun., Feb. 20, 2022 (2 p.m.)
  WORKSHOP - Sat., Feb. 5, 2022 (9 a.m.-Noon)
  Retreat - Sat., Feb. 12, 2022 (9:30 am.-Noon)
  Practice - Sat., Feb. 19, 2022 (8:30-9:15 a.m.)
- I would like my child to attend: Session I - Workshop takes place on Sat., Feb. 5, 2022
- SESSION II
  Celebration - Sun., April 24, 2022 (2 p.m.)
  WORKSHOP - Sat., Feb. 5, 2022 (9 a.m.-Noon)
  WORKSHOP - Sat., April 2, 2022 (9 a.m.-Noon)
  Retreat - Sat., April 9, 2022 (9:30 am.-Noon)
  Practice - Sat., April 23, 2022 (8:30-9:15 a.m.)
- I would like my child to attend (select one): Session II & attend the workshop on
  Sat., Feb. 5, 2022 Session II & attend the workshop on
  Sat., April 2, 2022
- SESSION III
  Celebration - Sun., May 22, 2022 (2 p.m.)
  WORKSHOP - Sat., Feb. 5, 2022 (9 a.m.-Noon)
  WORKSHOP - Sat., April 2, 2022 (9 a.m.-Noon)
  WORKSHOP - Sat., May 7, 2022 (9 a.m.-Noon)
  Retreat - Sat., May 14, 2022 (9:30 am.-Noon)
  Practice - Sat., May 21, 2022 (8:30-9:15 a.m.)
- I would like my child to attend (select one): Session III & attend the workshop on
  Sat., Feb. 5, 2022 Session III & attend the workshop on
  Sat., April 2, 2022 Session III & attend the workshop on
  Sat., May 7, 2022
- MEDICAL INFORMATION
- Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- FAMILY DOCTOR
- What is the name of your family doctor? REQUIRED Please fill out this field. Please enter valid data.
- Phone number for your family doctor. REQUIRED Please fill out this field. Please enter valid data.

EMERGENCY CONTACT #1

List Emergency Contact (other than a parent(s).

First Name Please enter valid data.

Last Name Please enter valid data.

Relationship Please enter valid data.

Phone Number Please enter a phone number.

EMERGENCY CONTACT #2

List Emergency Contact (other than a parent(s).

First Name Please enter valid data.

Last Name Please enter valid data.

Relationship Please enter valid data.

Phone Number Please enter a phone number.

ARCHDIOCESE OF CINCINNATI YOUTH
PERMISSION FORM
Please download and read the Archdiocese of Cincinnati Permission, Release and Authorization to Seek Medical Treatment form ►

I have read and agree to the Archdiocese of Cincinnati Permission, Release and Authorization to Seek Medical Treatment form that has been provided in the block above. REQUIRED Yes No Please fill out this field.

PHOTO PERMISSION
I understand that Good Shepherd’s staff may take photos and videos during class activities for the purpose of promoting the programs via our website, Sunday bulletin, parish social media page (for example, Facebook, Twitter, Instagram), or news releases to local or diocesan papers. I give my permission for pictures that are taken of my family, adults and children, to be used for this purpose.

I have read and agree to the Photo Permission statement listed above. REQUIRED Yes No Please fill out this field.

Please be aware that we will continue to follow the guidelines of the Archdiocese of Cincinnati regarding social distancing and other precautions due to the pandemic. We appreciate your patience and flexibility in the event changes in the pandemic leads to restructuring of program dates and classroom capacities.

I have read and understand that we are following all Archdiocesan Guidelines related to the pandemic, and if changes occur with the pandemic we will adjust accordingly. REQUIRED Yes, I have read and agree to the statement above regarding the pandemic. Please fill out this field.

By clicking on the "I Agree" box, it will serve as your digital signature for this submission.

I Agree Please select this field.

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

Date REQUIRED Please fill out this field. Please enter a date.