Family Contact Information
Parent/Guardian Name 1
Parent/Guardian Name 1
Parent/Guardian Name 2
Parent/Guardian Name 2
Mailing Address
Mailing Address
Primary Phone *
Primary Phone
Student Information
Student Name *
Student Name
Student Birthdate *
Student Birthdate
Sacraments Already Received
Please indicate the sacraments your child HAS ALREADY RECEIVED.
Occasionally, we publish photos of Faith Formation students in communications from the parish such as bulletins, posters, the website, etc. Names of students are NEVER used. If you do not wish your child/children’s photograph used, please indicate below. The Faith Formation program diligently follows the requirements of the Child Online Privacy Act as laid out by the United States Government. I, (parent or legal guardian), on behalf of and as the parent or legal guardian of the following person, who is under eighteen (18) years of age, (minor named above) (hereinafter “the Minor”), hereby authorize the Roman Catholic Diocese of Phoenix (hereinafter “the Diocese”), all of its parishes, affiliated organizations and entities, and OLMC Parish (hereinafter, the“School”) to record the Minor’s picture in photographs, films, videotapes or other media during and in connection with the Minor’s education or participation in Diocesan activities or events, and to use the Minor’s picture on the Diocese website, in the Catholic Sun newspaper, or in any other media or publication without further compensation or permission. I further authorize the Diocese, its parishes, affiliated organizations, entities and agents, and/or the School to edit any recordings of the Minor’s likeness and/or voice and incorporate any such recordings into print publications, electronic publications, and to use and license others to use such publications, in any manner of media whatsoever, including unrestricted use for purposes of publicity, information, advertising and sale promotion. I understand that the Diocese exclusively owns all rights to these recordings irrespective of the form in which they are produced or used. I further agree to indemnify and hold the Diocese, its parishes, affiliated organizations, entities,licensees, employees and agents, and the School harmless from and against any claims and liability for damages, losses or expenses of any kind arising from the making or use of any recordings, including, without limitation, claims with respect to the Minor’s privacy or publicity. I have read and understand the contents hereof, and have the right and authority to execute this release and to give this indemnification. I understand that this Release is to be interpreted under the laws of the state of Arizona without resort to its conflict of laws rules, and I hereby submit to the jurisdiction of the courts of the state of Arizona with respect to any action arising under this Release.
Emergency Contact Information
Contact Name *
Contact Name
Contact Phone *
Contact Phone