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Faith Formation Registration

- Learn & Grow

Please fill out the form below to register for our Sunday Faith Formation classes. If you have any questions please contact Kerry Schlimgen at kschlimgen@saintsimon.org or 317-826-6000 x 180.
Faith Formation Registration
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- Are you currently a registered parishioner of St. Simon
- If not, Where? Please enter valid data.
- Family Name REQUIRED Please fill out this field. Please enter valid data.
- Father's Name REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Mother's Name REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- 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.
- Landline (Phone) Number (if applicable) Please enter a phone number.
- Sacrament Information
  Please list all children in your household that you will be registering for faith formation classes along with which sacraments they have completed and if known date/parish.
- Children 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.
  
  Child Lives with REQUIRED Mother & Father Mother Father Grandparent(s) Guardian Please fill out this field.
  
  Gender
  
  Date of Birth Please enter valid data.
  
  Current Grade Please enter valid data.
  
  Name of School Please enter valid data.
  
  Baptism Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  Penance Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  First Eucharist Date and Parish
  If know, please provide First Communion date and Parish Location
  Please enter valid data.
  
  Confirmation Date and Parish
  If know, please provide Confirmation date and Parish Location
  Please enter valid data.
  
  Are there any learning or medical concerns with should be aware?
  Please list below any medical conditions your child has such as chronic or serious illness; severe allergies or sensitivities including, but not limited to: food, medicine, insects, or heat; asthma; cancer; diabetes, heart condition; respiratory problems; seizures, urinary problems; hemophilia; frequent hospitalizations; vision or hearing difficulties, physical limitations, etc.
  
  Please list Childs Medication Taken Regularly
  Please list below any medications, treatments, or medical care your child receives on a regular basis that medical personnel may need to know about at the time of treatment for illness or injury.
  
  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.
  
  Child Lives with REQUIRED Mother & Father Mother Father Grandparent(s) Guardian Please fill out this field.
  
  Gender
  
  Date of Birth Please enter valid data.
  
  Current Grade Please enter valid data.
  
  Name of School Please enter valid data.
  
  Baptism Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  Penance Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  First Eucharist Date and Parish
  If know, please provide First Communion date and Parish Location
  Please enter valid data.
  
  Confirmation Date and Parish
  If know, please provide Confirmation date and Parish Location
  Please enter valid data.
  
  Are there any learning or medical concerns with should be aware?
  Please list below any medical conditions your child has such as chronic or serious illness; severe allergies or sensitivities including, but not limited to: food, medicine, insects, or heat; asthma; cancer; diabetes, heart condition; respiratory problems; seizures, urinary problems; hemophilia; frequent hospitalizations; vision or hearing difficulties, physical limitations, etc.
  
  Please list Childs Medication Taken Regularly
  Please list below any medications, treatments, or medical care your child receives on a regular basis that medical personnel may need to know about at the time of treatment for illness or injury.
  
  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.
  
  Child Lives with REQUIRED Mother & Father Mother Father Grandparent(s) Guardian Please fill out this field.
  
  Gender
  
  Date of Birth Please enter valid data.
  
  Current Grade Please enter valid data.
  
  Name of School Please enter valid data.
  
  Baptism Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  Penance Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  First Eucharist Date and Parish
  If know, please provide First Communion date and Parish Location
  Please enter valid data.
  
  Confirmation Date and Parish
  If know, please provide Confirmation date and Parish Location
  Please enter valid data.
  
  Are there any learning or medical concerns with should be aware?
  Please list below any medical conditions your child has such as chronic or serious illness; severe allergies or sensitivities including, but not limited to: food, medicine, insects, or heat; asthma; cancer; diabetes, heart condition; respiratory problems; seizures, urinary problems; hemophilia; frequent hospitalizations; vision or hearing difficulties, physical limitations, etc.
  
  Please list Childs Medication Taken Regularly
  Please list below any medications, treatments, or medical care your child receives on a regular basis that medical personnel may need to know about at the time of treatment for illness or injury.
  
  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.
  
  Child Lives with REQUIRED Mother & Father Mother Father Grandparent(s) Guardian Please fill out this field.
  
  Gender
  
  Date of Birth Please enter valid data.
  
  Current Grade Please enter valid data.
  
  Name of School Please enter valid data.
  
  Baptism Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  Penance Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  First Eucharist Date and Parish
  If know, please provide First Communion date and Parish Location
  Please enter valid data.
  
  Confirmation Date and Parish
  If know, please provide Confirmation date and Parish Location
  Please enter valid data.
  
  Are there any learning or medical concerns with should be aware?
  Please list below any medical conditions your child has such as chronic or serious illness; severe allergies or sensitivities including, but not limited to: food, medicine, insects, or heat; asthma; cancer; diabetes, heart condition; respiratory problems; seizures, urinary problems; hemophilia; frequent hospitalizations; vision or hearing difficulties, physical limitations, etc.
  
  Please list Childs Medication Taken Regularly
  Please list below any medications, treatments, or medical care your child receives on a regular basis that medical personnel may need to know about at the time of treatment for illness or injury.
  
  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.
  
  Child Lives with REQUIRED Mother & Father Mother Father Grandparent(s) Guardian Please fill out this field.
  
  Gender
  
  Date of Birth Please enter valid data.
  
  Current Grade Please enter valid data.
  
  Name of School Please enter valid data.
  
  Baptism Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  Penance Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  First Eucharist Date and Parish
  If know, please provide First Communion date and Parish Location
  Please enter valid data.
  
  Confirmation Date and Parish
  If know, please provide Confirmation date and Parish Location
  Please enter valid data.
  
  Are there any learning or medical concerns with should be aware?
  Please list below any medical conditions your child has such as chronic or serious illness; severe allergies or sensitivities including, but not limited to: food, medicine, insects, or heat; asthma; cancer; diabetes, heart condition; respiratory problems; seizures, urinary problems; hemophilia; frequent hospitalizations; vision or hearing difficulties, physical limitations, etc.
  
  Please list Childs Medication Taken Regularly
  Please list below any medications, treatments, or medical care your child receives on a regular basis that medical personnel may need to know about at the time of treatment for illness or injury.
  
  Child 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.
  
  Child Lives with REQUIRED Mother & Father Mother Father Grandparent(s) Guardian Please fill out this field.
  
  Gender
  
  Date of Birth Please enter valid data.
  
  Current Grade Please enter valid data.
  
  Name of School Please enter valid data.
  
  Baptism Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  Penance Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  First Eucharist Date and Parish
  If know, please provide First Communion date and Parish Location
  Please enter valid data.
  
  Confirmation Date and Parish
  If know, please provide Confirmation date and Parish Location
  Please enter valid data.
  
  Are there any learning or medical concerns with should be aware?
  Please list below any medical conditions your child has such as chronic or serious illness; severe allergies or sensitivities including, but not limited to: food, medicine, insects, or heat; asthma; cancer; diabetes, heart condition; respiratory problems; seizures, urinary problems; hemophilia; frequent hospitalizations; vision or hearing difficulties, physical limitations, etc.
  
  Please list Childs Medication Taken Regularly
  Please list below any medications, treatments, or medical care your child receives on a regular basis that medical personnel may need to know about at the time of treatment for illness or injury.
  
  Child 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.
  
  Child Lives with REQUIRED Mother & Father Mother Father Grandparent(s) Guardian Please fill out this field.
  
  Gender
  
  Date of Birth Please enter valid data.
  
  Current Grade Please enter valid data.
  
  Name of School Please enter valid data.
  
  Baptism Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  Penance Date and Parish
  If know, please provide baptism date and Parish Location
  Please enter valid data.
  
  First Eucharist Date and Parish
  If know, please provide First Communion date and Parish Location
  Please enter valid data.
  
  Confirmation Date and Parish
  If know, please provide Confirmation date and Parish Location
  Please enter valid data.
  
  Are there any learning or medical concerns with should be aware?
  Please list below any medical conditions your child has such as chronic or serious illness; severe allergies or sensitivities including, but not limited to: food, medicine, insects, or heat; asthma; cancer; diabetes, heart condition; respiratory problems; seizures, urinary problems; hemophilia; frequent hospitalizations; vision or hearing difficulties, physical limitations, etc.
  
  Please list Childs Medication Taken Regularly
  Please list below any medications, treatments, or medical care your child receives on a regular basis that medical personnel may need to know about at the time of treatment for illness or injury.
- Health Insurance Information
- Company REQUIRED Please fill out this field. Please enter valid data.
- Policy Holder REQUIRED Please fill out this field. Please enter valid data.
- Group ID Number REQUIRED Please fill out this field. Please enter valid data.
- Holder ID Number Please enter valid data.
- Plan ID Please enter valid data.
- Local Hospital of Choice REQUIRED Please fill out this field. Please enter valid data.
- Physician of Choice REQUIRED Please fill out this field. Please enter valid data.
- Physician Phone Number REQUIRED Please fill out this field. Please enter valid data.
- I understand that in the case of a serious medical emergency, unless the injury/illness appears to be immediately life-threatening, the staff will make reasonable attempts to contact me/us as specified above before authorizing medical treatment. If I/we are not available to give consent, I/we hereby authorize the staff of (school, parish, or archdiocesan program) to act on my/our behalf, to call 911 emergency services, transport by ambulance, hospitalize; secure proper treatment; authorize injections, anesthesia, x-ray, surgery or other treatment for my child as deemed necessary by qualified medical personnel. I also understand that the medical information provided will be shared only on a medical “need-to-know” basis among staff and with treating medical personnel.
  
  Notice is hereby given to qualified medical personnel that this authorization is currently in effect, and such personnel are directed to act upon this authorization without delay. I/we agree to assume financial responsibility for all expenses incurred in any emergency requiring medical attention.
- I Agree Please select this field.
- 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 REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Emergency Contact Information
  Please list two contacts
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Faith Formation Fees
- Faith Formation fees can be paid via our FaithDirect portal. Please click the link below to submit payment.
  
  https://membership.faithdirect.net/events/details/7299
  
  1 Child: $75
  2 Children: $125
  3 Children: $150
  4 Children or More: $165
  
  If financial assistance would be helpful please contact the Faith Formation Office at 317.826.6000 x 180
- Flocknote Communication
- Your email and cell phone information will be added to our Flocknote Communication platform. Flocknote is the communication tool that the parish uses to keep you up-to-date on everything that happens at St. Simon. You have full control of what updates and how you receive those updates by logging into your account. You can also follow different parish ministries on Flocknote for specific ministry updates.
  
  Please give us 3-5 business days to set-up your account. To access your account you will use the e-mail address provided and click "I forgot my password." An email will be sent to you to set-up a new password. If you have any questions about Flocknote please contact the parish office at 317.826.6000.
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Saint Simon the Apostle

A Community of Prayer, Praise and Worship

Faith Formation Registration

Faith Formation Registration