On Line Giving | Pastor's Comments

Student Information / Release Form

This form is to be completed by Parent/Guardian  We must have a signature on file, so you must print this form, fill it out and sign it, and return it to the Faith Formation staff.  It can be delivered to the office or faxed.
There is a "link" to View Printable Page on the right side just above these instructions.

ST. FRANCES CABRINI CHURCH - Student Information / Release From

I, ____________________________________ am a parent or legal guardian of the following children:
_____________________________________             ___________________________________________
_____________________________________            ___________________________________________
_____________________________________
My child has an Individual Education Plan (IEP) at place in her/her school:     ________  YES    ________ NO
I would like to speak with program staff to discuss my child's needs:             ________  YES    ________ NO
Please list information related to special needs, allergies, food restrictions, and activity restrictions for each child:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
My child ______ MAY ______ MAY NOT be photographed for use on parish bulletin boards, website and other promotional material,

The following individual(s) is/are  NOT allowed to pick up my child: _______________________________________.

I understand that only my child's teacher and the program staff will have access to this information.  In the case of a
medical emergency or if a child requires the administration of an Epi-pen, 911 will be called and the child will
be transported to Fairview University Hospital at Riverside.  Parents/Guardians will be contacted at the number below.

_________________________________________    ______________   ___________________________________________
Signature of Parent/Guardian                                    Date                   Phone number to call in case of emergency.

Please return this authorization to: 
Faith Formation Staff   St. Frances Cabrini Church   1500 Franklin Ave SE  Mpls  55414
You may also fax this completed form to 612-339-0734