Faith Fusion

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

2nd Child Registration

4th Child Registration

3rd Child Registration

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.

Contact Us