Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Father's First Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Full Name (First Name Last Name) REQUIRED Please fill out this field. Please enter valid data.

Are both parents Catholic? REQUIRED Yes No Please fill out this field.

Email Address REQUIRED Please fill out this field. Please enter an email address.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Address Line 1 REQUIRED Please fill out this field. Please enter valid data.

Address Line 2 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.

Best Way to Reach You REQUIRED Email Phone Please fill out this field.

Emergency Contact (First Name Last Name) REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Cell Phone REQUIRED Please fill out this field. Please enter a phone number.

MEDICAL RELEASE AND INFORMATION

In case of an accident or serious illness, I request St. Thomas of Canterbury Church to contact me. If they are unable to reach me, I hereby authorize them to call my youth's primary physician, indicated below, and follow his/her instructions. If the physician cannot be reached, they may make the necessary arrangement.

I Agree Please select this field.

Physician Name (First Name Last Name) REQUIRED Please fill out this field. Please enter valid data.

Physician's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Insurance Provider REQUIRED Please fill out this field. Please enter valid data.

Insurance Policy Number REQUIRED Please fill out this field. Please enter valid data.

Number of child or children you are registering for 2021 - 2022 REQUIRED Please fill out this field.
Child 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.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade REQUIRED Please fill out this field.
- What school does your child attend? REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received (Please check all that apply) None Baptism First Eucharist First Reconciliation Confirmation
- Does your child have Allergies, Medications or Medical Conditions we should be aware of? REQUIRED Yes No Please fill out this field.
- Allergies, Medications or Medical Conditions Please enter valid data.
- Choose which class your child will be taking: REQUIRED Please fill out this field.
- Sacrament Preparation REQUIRED Please fill out this field.
Child 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.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade REQUIRED Please fill out this field.
- What school does your child attend? REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received (Please check all that apply) None Baptism First Eucharist First Reconciliation Confirmation
- Does your child have Allergies, Medications or Medical Conditions we should be aware of? REQUIRED Yes No Please fill out this field.
- Allergies, Medications or Medical Conditions Please enter valid data.
- Choose which class your child will be taking: REQUIRED Please fill out this field.
- Sacrament Preparation REQUIRED Please fill out this field.
Child 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.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade REQUIRED Please fill out this field.
- What school does your child attend? REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received (Please check all that apply) None Baptism First Eucharist First Reconciliation Confirmation
- Does your child have Allergies, Medications or Medical Conditions we should be aware of? REQUIRED Yes No Please fill out this field.
- Allergies, Medications or Medical Conditions Please enter valid data.
- Choose which class your child will be taking: REQUIRED Please fill out this field.
- Sacrament Preparation REQUIRED Please fill out this field.
Child 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.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade REQUIRED Please fill out this field.
- What school does your child attend? REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received (Please check all that apply) None Baptism First Eucharist First Reconciliation Confirmation
- Does your child have Allergies, Medications or Medical Conditions we should be aware of? REQUIRED Yes No Please fill out this field.
- Allergies, Medications or Medical Conditions Please enter valid data.
- Choose which class your child will be taking: REQUIRED Please fill out this field.
- Sacrament Preparation REQUIRED Please fill out this field.
Child 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.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade REQUIRED Please fill out this field.
- What school does your child attend? REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received (Please check all that apply) None Baptism First Eucharist First Reconciliation Confirmation
- Does your child have Allergies, Medications or Medical Conditions we should be aware of? REQUIRED Yes No Please fill out this field.
- Allergies, Medications or Medical Conditions Please enter valid data.
- Choose which class your child will be taking: REQUIRED Please fill out this field.
- Sacrament Preparation REQUIRED Please fill out this field.

REGISTRATION FEES ($0 For children in Catholic Schools who are enrolled in Religious Education): REQUIRED

Depending on the number of students you are registering, please choose the correct fees.

$100 (One child) $150 (Two children) $200 (Three children) $0 (Catholic School Religious Education) Please fill out this field.

ADDITIONAL SACRAMENT PREPARATION FEES REQUIRED

If you do not have any children preparing for sacraments, use $0; otherwise check the appropriate additional fees.

$0 NO SACRAMENT PREP $100 FIRST COMMUNION / FIRST RECONCILIATION $100 CONFIRMATION YEAR 1 / YEAR 2 Please fill out this field.

ADD REGISTRATION FEE + SACRAMENT PREP FEE (Example: $150 + 100 = $250) REQUIRED

Please tally up REGISTRATION FEES and ADDITIONAL SACRAMENT PREPARATION FEES here.

Please fill out this field. Please enter valid data.

USING CHECK PAYMENT (Write your check number here and drop/mail your check to parish office, please add Faith Formation on check memo))

Please tally up REGISTRATION FEES and ADDITIONAL SACRAMENT PREPARATION FEES here.

Please enter valid data.

USING WESHARE ONLINE PAYMENT

We are excited to offer WESHARE Online Payment (Credit Card or Debit Card) for this year's Faith Formation Registration. Please make a note of the total registration fees before clicking on the payment button below. This button will take you to a new window to complete your payment transation.

Please return to the online registration window to submit your registration after your payment.

WeShare PAYMENT BUTTON

PHOTO RELEASE REQUIRED I Agree I Do Not Agree Please fill out this field.

for my child to be photographed and/or video recorded during Faith Formation activities and events. I understand that my child may decline to be photographed and/or video recorded at any time. Photographs ad video footages may be edited, if necessary, and may be published and/or broadcast for the purpose of promotion.

IMPORTANT :
A Consent & Release - Virtual Media form MUST be completed. Please download these forms, fill them out and return them to the parish office.

Download Virtual Consent Form
Download DSJ Media Release Form

St Thomas of Canterbury

1522 McCoy Avenue, San Jose, CA 95130
408-378-1595

FAITH FORMATION ONLINE REGISTRATION

USING WESHARE ONLINE PAYMENT