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Online Registration

Welcome to St. Anne's Religious Education Program

We are excited to begin this new school year with you! Please fill out the registration form below with your student(s) information. When you have completed registration, please fill out the media release form and the COVID waiver found under the "Documents" section to the left. If you are interested, the CCD schedule is available to view under the "Religious Ed For Children" section or may be downloaded from the links under the "Documents" to the left.

If you have any issues you may call the parish office at (850) 456-5966 or email our DRE at [email protected].
Thank you and God bless.
The maximum number of form submissions has been reached. This form is currently not available.
- Number of Students to Register REQUIRED Please fill out this field.
  
  Student 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  Church Student is Currently Attending Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Sex REQUIRED Please fill out this field.
  
  Class to Register For REQUIRED Please fill out this field.
  
  School Student is Currently Attending Please enter valid data.
  
  Sacraments Which Have Already Been Received Baptism Confession Communion Confirmaton
  
  * The following is only required for those who will be receiving the Sacraments of First Holy Communion and/or Confirmation:
  
  Age When Baptized (Years) Please enter an integer (number).
  
  Date When Baptized Please enter a date.
  
  Church where Baptism was performed Please enter valid data.
  
  Church Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  * Annual Medical Info for this Child
  
  Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Policy Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance is provided by which parent and/or place of employment REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Address REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  MEDICATIONS: (EITHER A PHYSICIAN’S PRESCRIPTION OR A PARENT NOTE MUST ACCOMPANY ALL MEDICATIONS. PRESCRIPTION / NOTE SHOULD BE ATTACHED TO THIS FORM.) My child is taking the following medication(s). Please provide description and dosage of each:
  
  Description and Dosage of each:
  
  Drug Allergies Please enter valid data.
  
  Other Allergies (food, plants, insects, etc.) Please enter valid data.
  
  Other known diseases, disorders, or disabilites Please enter valid data.
  
  Student 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  Church Student is Currently Attending Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Sex REQUIRED Please fill out this field.
  
  Class to Register For REQUIRED Please fill out this field.
  
  School Student is Currently Attending Please enter valid data.
  
  Sacraments Which Have Already Been Received Baptism Confession Communion Confirmaton
  
  * The following is only required for those who will be receiving the Sacraments of First Holy Communion and/or Confirmation:
  
  Age When Baptized (Years) Please enter an integer (number).
  
  Date When Baptized Please enter a date.
  
  Church where Baptism was performed Please enter valid data.
  
  Church Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  * Annual Medical Info for this Child
  
  Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Policy Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance is provided by which parent and/or place of employment REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Address REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  MEDICATIONS: (EITHER A PHYSICIAN’S PRESCRIPTION OR A PARENT NOTE MUST ACCOMPANY ALL MEDICATIONS. PRESCRIPTION / NOTE SHOULD BE ATTACHED TO THIS FORM.) My child is taking the following medication(s). Please provide description and dosage of each:
  
  Description and Dosage of each:
  
  Drug Allergies Please enter valid data.
  
  Other Allergies (food, plants, insects, etc.) Please enter valid data.
  
  Other known diseases, disorders, or disabilites Please enter valid data.
  
  Student 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  Church Student is Currently Attending Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Sex REQUIRED Please fill out this field.
  
  Class to Register For REQUIRED Please fill out this field.
  
  School Student is Currently Attending Please enter valid data.
  
  Sacraments Which Have Already Been Received Baptism Confession Communion Confirmaton
  
  * The following is only required for those who will be receiving the Sacraments of First Holy Communion and/or Confirmation:
  
  Age When Baptized (Years) Please enter an integer (number).
  
  Date When Baptized Please enter a date.
  
  Church where Baptism was performed Please enter valid data.
  
  Church Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  * Annual Medical Info for this Child
  
  Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Policy Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance is provided by which parent and/or place of employment REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Address REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  MEDICATIONS: (EITHER A PHYSICIAN’S PRESCRIPTION OR A PARENT NOTE MUST ACCOMPANY ALL MEDICATIONS. PRESCRIPTION / NOTE SHOULD BE ATTACHED TO THIS FORM.) My child is taking the following medication(s). Please provide description and dosage of each:
  
  Description and Dosage of each:
  
  Drug Allergies Please enter valid data.
  
  Other Allergies (food, plants, insects, etc.) Please enter valid data.
  
  Other known diseases, disorders, or disabilites Please enter valid data.
  
  Student 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  Church Student is Currently Attending Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Sex REQUIRED Please fill out this field.
  
  Class to Register For REQUIRED Please fill out this field.
  
  School Student is Currently Attending Please enter valid data.
  
  Sacraments Which Have Already Been Received Baptism Confession Communion Confirmaton
  
  * The following is only required for those who will be receiving the Sacraments of First Holy Communion and/or Confirmation:
  
  Age When Baptized (Years) Please enter an integer (number).
  
  Date When Baptized Please enter a date.
  
  Church where Baptism was performed Please enter valid data.
  
  Church Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  * Annual Medical Info for this Child
  
  Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Policy Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance is provided by which parent and/or place of employment REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Address REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  MEDICATIONS: (EITHER A PHYSICIAN’S PRESCRIPTION OR A PARENT NOTE MUST ACCOMPANY ALL MEDICATIONS. PRESCRIPTION / NOTE SHOULD BE ATTACHED TO THIS FORM.) My child is taking the following medication(s). Please provide description and dosage of each:
  
  Description and Dosage of each:
  
  Drug Allergies Please enter valid data.
  
  Other Allergies (food, plants, insects, etc.) Please enter valid data.
  
  Other known diseases, disorders, or disabilites Please enter valid data.
  
  Student 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  Church Student is Currently Attending Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Sex REQUIRED Please fill out this field.
  
  Class to Register For REQUIRED Please fill out this field.
  
  School Student is Currently Attending Please enter valid data.
  
  Sacraments Which Have Already Been Received Baptism Confession Communion Confirmaton
  
  * The following is only required for those who will be receiving the Sacraments of First Holy Communion and/or Confirmation:
  
  Age When Baptized (Years) Please enter an integer (number).
  
  Date When Baptized Please enter a date.
  
  Church where Baptism was performed Please enter valid data.
  
  Church Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  * Annual Medical Info for this Child
  
  Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Policy Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance is provided by which parent and/or place of employment REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Address REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  MEDICATIONS: (EITHER A PHYSICIAN’S PRESCRIPTION OR A PARENT NOTE MUST ACCOMPANY ALL MEDICATIONS. PRESCRIPTION / NOTE SHOULD BE ATTACHED TO THIS FORM.) My child is taking the following medication(s). Please provide description and dosage of each:
  
  Description and Dosage of each:
  
  Drug Allergies Please enter valid data.
  
  Other Allergies (food, plants, insects, etc.) Please enter valid data.
  
  Other known diseases, disorders, or disabilites Please enter valid data.
  
  Student 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  Church Student is Currently Attending Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Sex REQUIRED Please fill out this field.
  
  Class to Register For REQUIRED Please fill out this field.
  
  School Student is Currently Attending Please enter valid data.
  
  Sacraments Which Have Already Been Received Baptism Confession Communion Confirmaton
  
  * The following is only required for those who will be receiving the Sacraments of First Holy Communion and/or Confirmation:
  
  Age When Baptized (Years) Please enter an integer (number).
  
  Date When Baptized Please enter a date.
  
  Church where Baptism was performed Please enter valid data.
  
  Church Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  * Annual Medical Info for this Child
  
  Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Policy Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance is provided by which parent and/or place of employment REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Address REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  MEDICATIONS: (EITHER A PHYSICIAN’S PRESCRIPTION OR A PARENT NOTE MUST ACCOMPANY ALL MEDICATIONS. PRESCRIPTION / NOTE SHOULD BE ATTACHED TO THIS FORM.) My child is taking the following medication(s). Please provide description and dosage of each:
  
  Description and Dosage of each:
  
  Drug Allergies Please enter valid data.
  
  Other Allergies (food, plants, insects, etc.) Please enter valid data.
  
  Other known diseases, disorders, or disabilites Please enter valid data.
  
  Student 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  Church Student is Currently Attending Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Sex REQUIRED Please fill out this field.
  
  Class to Register For REQUIRED Please fill out this field.
  
  School Student is Currently Attending Please enter valid data.
  
  Sacraments Which Have Already Been Received Baptism Confession Communion Confirmaton
  
  * The following is only required for those who will be receiving the Sacraments of First Holy Communion and/or Confirmation:
  
  Age When Baptized (Years) Please enter an integer (number).
  
  Date When Baptized Please enter a date.
  
  Church where Baptism was performed Please enter valid data.
  
  Church Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  * Annual Medical Info for this Child
  
  Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Policy Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance is provided by which parent and/or place of employment REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Address REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  MEDICATIONS: (EITHER A PHYSICIAN’S PRESCRIPTION OR A PARENT NOTE MUST ACCOMPANY ALL MEDICATIONS. PRESCRIPTION / NOTE SHOULD BE ATTACHED TO THIS FORM.) My child is taking the following medication(s). Please provide description and dosage of each:
  
  Description and Dosage of each:
  
  Drug Allergies Please enter valid data.
  
  Other Allergies (food, plants, insects, etc.) Please enter valid data.
  
  Other known diseases, disorders, or disabilites Please enter valid data.
  
  Student 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  Church Student is Currently Attending Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Sex REQUIRED Please fill out this field.
  
  Class to Register For REQUIRED Please fill out this field.
  
  School Student is Currently Attending Please enter valid data.
  
  Sacraments Which Have Already Been Received Baptism Confession Communion Confirmaton
  
  * The following is only required for those who will be receiving the Sacraments of First Holy Communion and/or Confirmation:
  
  Age When Baptized (Years) Please enter an integer (number).
  
  Date When Baptized Please enter a date.
  
  Church where Baptism was performed Please enter valid data.
  
  Church Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  * Annual Medical Info for this Child
  
  Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Policy Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance is provided by which parent and/or place of employment REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Address REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  MEDICATIONS: (EITHER A PHYSICIAN’S PRESCRIPTION OR A PARENT NOTE MUST ACCOMPANY ALL MEDICATIONS. PRESCRIPTION / NOTE SHOULD BE ATTACHED TO THIS FORM.) My child is taking the following medication(s). Please provide description and dosage of each:
  
  Description and Dosage of each:
  
  Drug Allergies Please enter valid data.
  
  Other Allergies (food, plants, insects, etc.) Please enter valid data.
  
  Other known diseases, disorders, or disabilites Please enter valid data.
  
  Student 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Nickname Please enter valid data.
  
  Church Student is Currently Attending Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Sex REQUIRED Please fill out this field.
  
  Class to Register For REQUIRED Please fill out this field.
  
  School Student is Currently Attending Please enter valid data.
  
  Sacraments Which Have Already Been Received Baptism Confession Communion Confirmaton
  
  * The following is only required for those who will be receiving the Sacraments of First Holy Communion and/or Confirmation:
  
  Age When Baptized (Years) Please enter an integer (number).
  
  Date When Baptized Please enter a date.
  
  Church where Baptism was performed Please enter valid data.
  
  Church Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  * Annual Medical Info for this Child
  
  Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Policy Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance is provided by which parent and/or place of employment REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Address REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  MEDICATIONS: (EITHER A PHYSICIAN’S PRESCRIPTION OR A PARENT NOTE MUST ACCOMPANY ALL MEDICATIONS. PRESCRIPTION / NOTE SHOULD BE ATTACHED TO THIS FORM.) My child is taking the following medication(s). Please provide description and dosage of each:
  
  Description and Dosage of each:
  
  Drug Allergies Please enter valid data.
  
  Other Allergies (food, plants, insects, etc.) Please enter valid data.
  
  Other known diseases, disorders, or disabilites Please enter valid data.
- Main Contact Person for All Students
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to child(ren) REQUIRED Please fill out this field.
  
  Explanation for choosing 'Other' Please enter valid data.
  
  Address REQUIRED 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.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Religion Please enter valid data.
  
  Church Currently Attending Please enter valid data.
  
  Occupation Please enter valid data.
  
  Volunteer Opportunities Willing to Teach Willing to be an Assistant Willing to be a Substitute
- Responsible Adults
  (You do not have to re-enter the 'Main Contact' person's info)
- Number of Responsible Adults to Add REQUIRED Please fill out this field.
  
  Responsible Adult 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Adults Role REQUIRED May Pickup Child(ren) Emergency Contact for Child(ren) Please fill out this field.
  
  Relationship REQUIRED Please fill out this field.
  
  Explanation for Choosing Other Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email Please enter an email address.
  
  Religion Please enter valid data.
  
  Church Attending Please enter valid data.
  
  Occupation Please enter valid data.
  
  Volunteer Opportunites Willing to Teach Willing to be an Assistant Willing to be a Substitute
  
  Responsible Adult 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Adults Role REQUIRED May Pickup Child(ren) Emergency Contact for Child(ren) Please fill out this field.
  
  Relationship REQUIRED Please fill out this field.
  
  Explanation for Choosing Other Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email Please enter an email address.
  
  Religion Please enter valid data.
  
  Church Attending Please enter valid data.
  
  Occupation Please enter valid data.
  
  Volunteer Opportunites Willing to Teach Willing to be an Assistant Willing to be a Substitute
  
  Responsible Adult 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Adults Role REQUIRED May Pickup Child(ren) Emergency Contact for Child(ren) Please fill out this field.
  
  Relationship REQUIRED Please fill out this field.
  
  Explanation for Choosing Other Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email Please enter an email address.
  
  Religion Please enter valid data.
  
  Church Attending Please enter valid data.
  
  Occupation Please enter valid data.
  
  Volunteer Opportunites Willing to Teach Willing to be an Assistant Willing to be a Substitute
  
  Responsible Adult 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Adults Role REQUIRED May Pickup Child(ren) Emergency Contact for Child(ren) Please fill out this field.
  
  Relationship REQUIRED Please fill out this field.
  
  Explanation for Choosing Other Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email Please enter an email address.
  
  Religion Please enter valid data.
  
  Church Attending Please enter valid data.
  
  Occupation Please enter valid data.
  
  Volunteer Opportunites Willing to Teach Willing to be an Assistant Willing to be a Substitute
  
  Responsible Adult 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Adults Role REQUIRED May Pickup Child(ren) Emergency Contact for Child(ren) Please fill out this field.
  
  Relationship REQUIRED Please fill out this field.
  
  Explanation for Choosing Other Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email Please enter an email address.
  
  Religion Please enter valid data.
  
  Church Attending Please enter valid data.
  
  Occupation Please enter valid data.
  
  Volunteer Opportunites Willing to Teach Willing to be an Assistant Willing to be a Substitute
  
  Responsible Adult 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Adults Role REQUIRED May Pickup Child(ren) Emergency Contact for Child(ren) Please fill out this field.
  
  Relationship REQUIRED Please fill out this field.
  
  Explanation for Choosing Other Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email Please enter an email address.
  
  Religion Please enter valid data.
  
  Church Attending Please enter valid data.
  
  Occupation Please enter valid data.
  
  Volunteer Opportunites Willing to Teach Willing to be an Assistant Willing to be a Substitute
- Other Brothers and/or Sisters
- Number of other Siblings not being registered REQUIRED Please fill out this field.
  
  Sibling 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sibling 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sibling 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sibling 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Media Release
- It is the promise and commitment of the Diocese of Pensacola-Tallahassee to use pictures and videos from Diocesan and/or parish youth events in a dignified and respectful manner.
  
  Choose I Accept if you accept the media release conditions as follows:
  
  I hereby authorize the Diocese of Pensacola-Tallahassee, including its parishes, schools, and institutions (hereinafter referred to as “Diocese of Pensacola-Tallahassee”) to use, prepare, reproduce, record, video tape, publish, distribute, broadcast, electronically store, and exhibit my name, image, portrait, likeness, words, and/or voice in connection with interviews, sessions, or events conducted, sponsored, or arranged by the Diocese of Pensacola-Tallahassee and its employees, volunteers, and agents. I acknowledge that any notes, photographs, motion pictures, digital images, recordings, or other media format taken of me will become the property of the Diocese of Pensacola-Tallahassee, and I specifically waive any right to compensation for the foregoing. I understand that my likeness, name, image, or voice may be used by the Diocese of Pensacola-Tallahassee without limitation for any professional purpose, now or in the future, and I consent to the same. This permission extends to any authorized print or broadcast media organization that may participate in such preparation, use, reproduction, publication, or distribution.
  
  I release the Diocese of Pensacola-Tallahassee and its employees, volunteers, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use. I also hereby waive any right I may have to inspect and approve in advance the photographs, videos, sound recordings, or publications or media in which I am included. I agree to release the Diocese of Pensacola-Tallahassee and its employees, volunteers, agents and designees from any liability by virtue of the use of the photographs or video recordings, regardless of any blurring, distortion, optical illusion, or alteration which may occur when the photographs or videos are taken, printed, or displayed.
  
  Choose I Do Not Accept if you do not accept the media release conditions:
  
  I DO NOT authorize or release the Diocese of Pensacola-Tallahassee, to use, prepare, reproduce, record, video tape, publish, distribute, broadcast, electronically store, and exhibit my name, image, portrait, likeness, words, and/or voice in connection with interviews, sessions, or events conducted, sponsored, or arranged by the Diocese of PensacolaTallahassee and its employees, volunteers, and agents.
  
  By checking the I Accept or I Do Not Accept box, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting I Accept or I Do Not Accept you consent to be legally bound by this Agreement's terms and conditions.
  
  Please Accept or Do Not Accept the Media Release REQUIRED I Accept I Do Not Accept Please fill out this field.
- Emergency Medial Treatment Statement of Consent and Release of Liability
- If you would like your youth to participate in parish activities, please sign and return the following statement of consent and release of liability.
  
  As parent or legal guardian, you remain fully responsible for any legal responsibility which may result from any personal actions taken by your youth.
  
  In consideration for the opportunity for my child to participate in parish activities, and fully recognizing that such an undertaking involves an element of risk, we assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify and agree to hold harmless the Diocese of Pensacola- Tallahassee and St. Anne Bellview Parish, and their employees, agents, volunteers, and other persons acting on their behalf. Neither the Diocese of Pensacola-Tallahassee, St. Anne Bellview Parish, nor said agents, employees, or volunteers, shall be held financially responsible for any injury, illness or death incurred as a direct or indirect result of this activity. We the undersigned have read this release and understand all its terms and execute it voluntarily and with full knowledge of its significance.
  
  EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I/we hereby authorize the Diocese of Pensacola-Tallahassee, and St. Anne Bellview Parish, through its authorized representatives, to transport my child to a hospital or other doctor’s office or medical facility for emergency medical attention. I/ We additionally authorize such representatives of the Diocese and/or School to obtain and give consent to whatever medical treatment the representative deems necessary, including the administering of anesthetic and surgery, and do hereby release the Diocese and St. Anne Bellview Parish, and their authorized representatives from any and all claims which may arise from the above-referenced obtaining and consenting to medical treatment. I/We wish to be advised, if possible, prior to the providing of any non-emergency medical treatment by any physician or hospital.
  
  Choose I Accept if you agree to this statement otherwise choose I Do Not Accept.
  
  By checking the I Accept or I Do Not Accept box, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting I Accept or I Do Not Accept you consent to be legally bound by this Agreement's terms and conditions.
  
  Please Accept or Do Not Accept the Statement of Consent and Release of Liability for Emergency Medical Treatment REQUIRED I Accept I Do Not Accept Please fill out this field.
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St. Anne Catholic Church

Bellview, Florida

Online Registration

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Welcome to St. Anne's Religious Education Program