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Our Lady of Mercy Church
16 Baboosic Lake Road, Merrimack NH - (603) 424-3757
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Home
About Us
Staff
Parish Finances
Faith Formation
Faith Formation Information
Sacramental Programs
RCIA
Additional Resources
Ministries and Groups
Comfort Ministry
Faithful Citizenship/Life Matters
Knights of Columbus
Knitting Ministry
Liturgical Ministers
Moms & Tots
Music Ministry
Prayer Group & Rosary Cenacle
Youth Ministry
News / Events
Bulletins
Events
News
Online Registration 2020-2021
Faith Formation
Faith Formation Information
Program Descriptions
Online Registration
Online Payments
Sacramental Programs
RCIA
Additional Resources
The maximum number of form submissions has been reached. This form is currently not available.
Father/Guardian Information:
Name
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Cell Phone Number
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Mother/Guardian Information:
Name
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Maiden Name
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Primary/Home Phone Number
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Cell Phone Number
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Primary Email (for teacher or office to use as a contact):
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Mailing Address
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Mother
Father
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I agree that the to the best of my knowledge the information on this form is accurate and true. I also agree that I have received and read a copy of the policies and procedures for faith formation classes, events & activities.
I Agree
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Emergency Contact Information
If we are unable to reach you in an emergency, who should we contact instead:
First Name
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Last Name
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Emergency Contact Phone Number
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Relationship
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AUTHORIZED PICKUP
: If registering a student grades 1-5 for a classroom program, please list 2 individuals
other than parents
that are authorized to pick up your child.
Name of Authorized Person
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Phone Number
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Name of Authorized Person
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Phone Number
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PHOTOGRAPH PERMISSION:
Photographs are sometimes taken during faith formation sessions and events. They are displayed publically; i.e. on the parish website, parish facebook page, newspaper, brochure, bulletin boards, etc. and used to keep the community aware and informed of parish events and activities.
If you do not want images taken and used as described,
please send written notice
to that effect to Michael Coughlin at the Parish Office, 16 Baboosic Lake Road, Merrimack NH 03054.
Please list below any circumstances that the teacher should be made aware of that might affect your child's abilities or behavior in the classroom - i.e. learning disabilities, hyperactivity, speech problems, medical issues, etc. Please be sure to identify the family member(s) to which the circumstances apply. (This information is kept confidential and is given only to the teacher and aide.)
Does your child receive professional support at school for developmental needs? If YES, a parent may be required to attend classes if needed.
REQUIRED
YES
NO
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MEDICAL FORMS:
If your child carries an epi-pen, inhaler or other medical equipment with them during a session or event, please call Michael Coughlin, the Director of Parish Faith Formation Programs at 424-4477.
Student #1:
Name
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Grade as of September
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Date of Birth
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Class Selection
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Wednesdays 4:15-5:30 (Grades 1-5 only)
At home (Grades 1-5 only)
Wednesday Program 5:45-6:45pm (Gr 1-5 only)
Edge Program (Gr 6, 7 & 8)
Lifeteen (Grades 9-12)
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Received Baptism?
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YES
NO
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First Eucharist Received?
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YES
NO
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Confirmation Received?
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YES
NO
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Name of School Currently Attending
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Student #2:
Name
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Grade as of September
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Date of Birth
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Class Selection
None
Wednesdays 4:15-5:30 (Grades 1-5 only)
At home (Grades 1-5 only)
Wednesday Program 5:45-6:45pm (Grades 1-5 only)
Edge Program (Gr 6,7 &8)
Lifeteen (Grades 9-12)
Baptism Received?
YES
NO
First Eucharist Received?
YES
NO
Confirmation Received?
YES
NO
Name of School Currently Attending:
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Student #3:
Name
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Grade as of September
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Date of Birth
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Class Selection
None
Wednesdays 4:15-5:30 (Grades 1-5 only)
At home (Grades 1-5 only)
Wednesday Program 5:45-6:45pm (Grades 1-5 only)
Edge (Gr 6, 7 & 8)
Lifeteen (Grades 9-12)
Baptism Received?
YES
NO
First Eucharist Received?
YES
NO
Confirmation Received?
YES
NO
Name of School Currently Attending:
Please enter valid data.
Student #4:
Name
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Grade as of September
Please enter an integer (number).
Date of Birth
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Class Selection
None
Wednesdays 4:15-5:30 (Grades 1-5 only)
At home (Grades 1-5 only)
Wednesday Program 5:45-6:45pm
Edge Program (Gr 6,7 & 8)
Lifeteen (Grades 9-12)
Baptism Received?
YES
NO
First Eucharist Received?
YES
NO
Confirmation Received?
YES
NO
Name of School Currently Attending:
Please enter valid data.
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