Faith Fusion

- Faith Formation
Contact Us
- Susan Hack
  
  Adult Faith, RCIA, Baptism Prep, Inquiry
  
  398-3821 ext 3169
  hacksstsusanna.org

Faith Fusion is for students lacking prior religious education and/or in need of sacraments that are above the age of second grade
2017-2018 Faith Fusion Registration Form
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- Family Information
  
  Family Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED
  number and street name
  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.
  
  If mother and father's addresses are different, with whom does the child(ren) reside? Mother Father Guardian
  
  If mother's and father's addresses are different, who has legal custody of child(ren)? Mother Father Shared Guardian
- Father's Information
  
  If the Father’s information is unavailable please place an “X” in each field.
  
  Father's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  I would like to receive texts on this number for meeting reminders and information REQUIRED Yes No Please fill out this field.
  
  I would like to receive text on this number for St. Susanna Service Opportunities REQUIRED Yes No Please fill out this field.
  
  Father's Work Phone number REQUIRED Please fill out this field. Please enter valid data.
  
  Father's E-Mail Address REQUIRED Please fill out this field. Please enter valid data.
- Mother's Information
  
  If the Mother’s information is unavailable please place an “X” in each field.
  
  Mother’s Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother’s Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Mother’s Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  I would like to receive texts on this number for meeting reminders and information REQUIRED Yes No Please fill out this field.
  
  I would like to receive text on this number for St. Susanna Service Opportunities REQUIRED Yes No Please fill out this field.
  
  Mother’s Work Phone number REQUIRED Please fill out this field. Please enter valid data.
  
  Mother’s E-Mail Address REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Information
  
  Name of person to contact in an emergency if both parents are unreachable.
  
  Emergency Contact's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact's Phone Number REQUIRED Please fill out this field. Please enter valid data.
- 1st Child Registration
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child's Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Child's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies Please enter valid data.
  
  Medications Please enter valid data.
  
  Chronic Conditions Please enter valid data.
  
  Note to Faith Fusion Administration Please enter valid data.
- 2nd Child Registration
  
  Child's Full Name Please enter valid data.
  
  Child's Birthdate Please enter valid data.
  
  Child's Grade Please enter valid data.
  
  Allergies Please enter valid data.
  
  Medications Please enter valid data.
  
  Chronic Conditions Please enter valid data.
  
  Note to Faith Fusion Administration Please enter valid data.
- 4th Child Registration
  
  Child's Full Name Please enter valid data.
  
  Child's Birthdate Please enter valid data.
  
  Child's Grade Please enter valid data.
  
  Allergies Please enter valid data.
  
  Medications Please enter valid data.
  
  Chronic Conditions Please enter valid data.
  
  Note to Faith Fusion Administration Please enter valid data.
- 3rd Child Registration
  
  Child's Full Name Please enter valid data.
  
  Child's Birthdate Please enter valid data.
  
  Child's Grade Please enter valid data.
  
  Allergies Please enter valid data.
  
  Medications Please enter valid data.
  
  Chronic Conditions Please enter valid data.
  
  Note to Faith Fusion Administration Please enter valid data.
- Commitment to Participate
  
  I have read the description of the Faith Fusion Sessions and fully understand the commitment. REQUIRED Yes Please fill out this field.
- Payment Options
  
  $120 for 1 child, $230 for 2 children (either in CFP or Early Childhood), $300 for 3 or more children (either in CFP or Early Childhood). Payment must be made via Online Giving.
  
  Total Amount Due REQUIRED Please fill out this field.
  
  If you need financial assistance with your fees, please send your request through an email to Susan Hack or mail your request to the Parish Office.
- Please provide your e-mail address so that you receive a message of confirmation that this form has been submitted.
  Thank you.
- Email REQUIRED Please fill out this field. Please enter an email address.
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