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Rock StEdY Registration Form

New Rock Stedy registration form/ Spiritual Formation Registration
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- Please complete 1 registration form for each disciple, once completed please click the registration fee box to complete the payment process for the entire family. If you are a returning family please fill out the returning family registration form.
- Date REQUIRED Please fill out this field. Please enter a date.
- Disciple's Name/Nombre del discípulo
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Last Name REQUIRED Please fill out this field. Please enter valid data.
- Preferred Name Please enter valid data.
- Date of Birth Please enter valid data.
- Program Options Homeschool (Church provided curriculum, pre-approved parent choice) Spiritual Formation Class (In person in the Parish Hall)
- Grade Going In To REQUIRED Please fill out this field.
- Mother's Name Please enter valid data.
- Father's Name Please enter valid data.
- Address REQUIRED Please fill out this field. Please enter valid data.
- City Please enter valid data.
- State Please enter valid data.
- Zip Code Please enter valid data.
- email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Baptism (Date and Place) Please enter valid data.
- First Reconciliation (Date and Place) Please enter valid data.
- First Holy Communion (Date and Place) Please enter valid data.
- Emergency Contact - Name and Phone Number Please enter valid data.
- Special Needs/Allergies/Medical Conditions/Physical Restrictions
- For 4th Grade and up I give my Disciple permission to leave the Parish Hall without supervision after class. Yes No
- All Disciples in Groups Promise and Good News (Kinder - 3rd) must be signed in and out by a Parent.
- I give permission to St. Edward and/or Our Lady of Grace to photograph my Disciple during church related activities and to use those photos on our website, bulletin boards, newsletters, etc. Yes No
- Are you a registered member of St. Edward Parish? Yes No
- If no, at what Parish are you registered at? Please enter valid data.
- PARENTAL PERMISSION AND RELEASE AND WAIVER OF LIABILITY
  I agree to have my Disciple participate in the parish spiritual formation program.
  
  On behalf of the above named Disciple, I do herby release, waive, indemnify, hold harmless and defend the Roman Catholic Bishop of Las Cruces, and his successors, the Diocese of Las Cruces, St. Edward Parish, its officers, directors and agents, volunteers, chaperones, and/or representatives thereof from all damages and/or liability arising from or in connection with any activities undertaken as part of in relation to the Spiritual Formation program(s) of St. Edward, San Jose, Our Lady of Grace, Cristo Rey or the Diocese of Las Cruces.
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St. Edward Roman Catholic Church

Carlsbad, New Mexico

Rock StEdY Registration Form

New Rock Stedy registration form/ Spiritual Formation Registration