Holy Cross Faith Formation 22-23

Registration via SmartWaiver for Holy Cross Faith Formation is required. A separate waiver must be filled out for each child. We apologize for this inconvenience.

Once completed, please click "Agree To This Document" at the bottom.

***A fee of $20 to cover the cost of textbooks is required for each child. This fee can be turned into the church office, placed in the collection basket at Mass, or given to Jennifer Kirshner. ***

Participant's

Minor

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First Minor's Name

First Name*

Middle Name

Last Name*

First Minor's Date of Birth*

I certify that I am 18 years of age or older

First Minor's Signature*

Type Signature

Draw Signature

Click to Sign

Minor's Address

Address Line 1:*

Street address, P.O. box, company name, c/o

Address Line 2:

Apartment, suite, unit, building, floor, etc.

Country:*

City:*

State/Province:*

Zip/Postal:*

Parent or Guardian's Email Address

A signed copy of this waiver will be sent to the email address you provide.

Father/Primary Guardian's Information

First Name *

Last Name *

Address (if different from child)

Cell Phone # or Email Address for Remind Communication + Updates (cancellations, reminders, etc...)

Mother/Primary Guardian's Information

First Name *

Last Name *

Address (if different from child)

Cell Phone # or Email Address for Remind Communication + Updates (cancellations, reminders, etc...)

Emergency Contact and Phone Number

Emergency Contact's Name *

Emergency Contact's Phone Number *

Custody/Divorce Situations

Are there any current situations the faith formation teachers should be aware of regarding the safety of your child?*

Yes

If yes, please explain.

Is there anyone who is not permitted to be with or pick up your child?*

Yes

If yes, please explain.

Photo Release (via Diocese of Greensburg website)

By signing this waiver, I hereby grant the Diocese of Greensburg, Pennsylvania, and its respective licensees (Holy Cross), successors and assigns, the right and permission, with respect to those photographs taken of the minor named below on whose behalf I am signing, and with respect to any printed or electronic matter in connection therewith, to do the following:

1.To include such photographs on websites within the Diocese of Greensburg and social media sites, and on print material.

2.To use my name, or the name of the minor on whose behalf I am signing, in connection with the foregoing.

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.

Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Parent or Guardian's Date of Birth*

I certify that I am 18 years of age or older

Parent or Guardian's Signature*

Type Signature

Draw Signature

Click to Sign

Electronic Signature Consent*

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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Agree To This Document