Couple Information

Spouse 1 Name REQUIRED Please fill out this field. Please enter valid data.

Spouse 2 Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter valid data.

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

Childcare

Do you anticipate needing childcare? REQUIRED Yes No Please fill out this field.

Anticipated Largest Number of Children Requiring Childcare During Any One Session 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's Age REQUIRED Please fill out this field. Please enter valid data.
- Any medical or food allergies? REQUIRED Please fill out this field. Please enter valid data.
- Medical Release for Childcare
  
  As parent and/or legal guardian I remain legally responsible for any personal actions taken by the above-named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Catholic Diocese of Richmond, the Church of the Holy Family, their employees and agents, chaperones, or representatives associated with the event from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese and/or Church of the Holy Family, their employees and agents and chaperones, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese and/or Church of the Holy Family.
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. I hereby give permission to Church of the Holy Family to contact emergency services for the transportation of my child(ren) to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above number(s), I give permission for the noted emergency contact to be notified. I will not hold the Diocese of Richmond and/or the Church of the Holy Family responsible for authorizing any medical treatment beyond necessary transportation to the hospital.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
- Proximity Agreement for Childcare
  
  I agree to remain on the premises of Church of the Holy Family while my child(ren) is (are) signed into childcare. I understand that I may be contacted via cell phone if I am needed by my child(ren) (for a diaper change, consoling, etc). I agree to monitor my cell phone for such messages and arrive promptly should this occur.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
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's Age REQUIRED Please fill out this field. Please enter valid data.
- Any medical or food allergies? Please enter valid data.
- Medical Release for Childcare
  
  As parent and/or legal guardian I remain legally responsible for any personal actions taken by the above-named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Catholic Diocese of Richmond, the Church of the Holy Family, their employees and agents, chaperones, or representatives associated with the event from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese and/or Church of the Holy Family, their employees and agents and chaperones, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese and/or Church of the Holy Family.
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. I hereby give permission to Church of the Holy Family to contact emergency services for the transportation of my child(ren) to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above number(s), I give permission for the noted emergency contact to be notified. I will not hold the Diocese of Richmond and/or the Church of the Holy Family responsible for authorizing any medical treatment beyond necessary transportation to the hospital.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
- Proximity Agreement for Childcare
  
  I agree to remain on the premises of Church of the Holy Family while my child(ren) is (are) signed into childcare. I understand that I may be contacted via cell phone if I am needed by my child(ren) (for a diaper change, consoling, etc). I agree to monitor my cell phone for such messages and arrive promptly should this occur.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
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's Age REQUIRED Please fill out this field. Please enter valid data.
- Any medical or food allergies? Please enter valid data.
- Medical Release for Childcare
  
  As parent and/or legal guardian I remain legally responsible for any personal actions taken by the above-named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Catholic Diocese of Richmond, the Church of the Holy Family, their employees and agents, chaperones, or representatives associated with the event from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese and/or Church of the Holy Family, their employees and agents and chaperones, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese and/or Church of the Holy Family.
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. I hereby give permission to Church of the Holy Family to contact emergency services for the transportation of my child(ren) to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above number(s), I give permission for the noted emergency contact to be notified. I will not hold the Diocese of Richmond and/or the Church of the Holy Family responsible for authorizing any medical treatment beyond necessary transportation to the hospital.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
- Proximity Agreement for Childcare
  
  I agree to remain on the premises of Church of the Holy Family while my child(ren) is (are) signed into childcare. I understand that I may be contacted via cell phone if I am needed by my child(ren) (for a diaper change, consoling, etc). I agree to monitor my cell phone for such messages and arrive promptly should this occur.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
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's Age REQUIRED Please fill out this field. Please enter valid data.
- Any medical or food allergies? Please enter valid data.
- Medical Release for Childcare
  
  As parent and/or legal guardian I remain legally responsible for any personal actions taken by the above-named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Catholic Diocese of Richmond, the Church of the Holy Family, their employees and agents, chaperones, or representatives associated with the event from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese and/or Church of the Holy Family, their employees and agents and chaperones, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese and/or Church of the Holy Family.
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. I hereby give permission to Church of the Holy Family to contact emergency services for the transportation of my child(ren) to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above number(s), I give permission for the noted emergency contact to be notified. I will not hold the Diocese of Richmond and/or the Church of the Holy Family responsible for authorizing any medical treatment beyond necessary transportation to the hospital.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
- Proximity Agreement for Childcare
  
  I agree to remain on the premises of Church of the Holy Family while my child(ren) is (are) signed into childcare. I understand that I may be contacted via cell phone if I am needed by my child(ren) (for a diaper change, consoling, etc). I agree to monitor my cell phone for such messages and arrive promptly should this occur.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
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's Age REQUIRED Please fill out this field. Please enter valid data.
- Any medical or food allergies? Please enter valid data.
- Medical Release for Childcare
  
  As parent and/or legal guardian I remain legally responsible for any personal actions taken by the above-named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Catholic Diocese of Richmond, the Church of the Holy Family, their employees and agents, chaperones, or representatives associated with the event from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese and/or Church of the Holy Family, their employees and agents and chaperones, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese and/or Church of the Holy Family.
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. I hereby give permission to Church of the Holy Family to contact emergency services for the transportation of my child(ren) to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above number(s), I give permission for the noted emergency contact to be notified. I will not hold the Diocese of Richmond and/or the Church of the Holy Family responsible for authorizing any medical treatment beyond necessary transportation to the hospital.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
- Proximity Agreement for Childcare
  
  I agree to remain on the premises of Church of the Holy Family while my child(ren) is (are) signed into childcare. I understand that I may be contacted via cell phone if I am needed by my child(ren) (for a diaper change, consoling, etc). I agree to monitor my cell phone for such messages and arrive promptly should this occur.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
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's Age REQUIRED Please fill out this field. Please enter valid data.
- Any medical or food allergies? Please enter valid data.
- Medical Release for Childcare
  
  As parent and/or legal guardian I remain legally responsible for any personal actions taken by the above-named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Catholic Diocese of Richmond, the Church of the Holy Family, their employees and agents, chaperones, or representatives associated with the event from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese and/or Church of the Holy Family, their employees and agents and chaperones, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese and/or Church of the Holy Family.
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. I hereby give permission to Church of the Holy Family to contact emergency services for the transportation of my child(ren) to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above number(s), I give permission for the noted emergency contact to be notified. I will not hold the Diocese of Richmond and/or the Church of the Holy Family responsible for authorizing any medical treatment beyond necessary transportation to the hospital.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
- Proximity Agreement for Childcare
  
  I agree to remain on the premises of Church of the Holy Family while my child(ren) is (are) signed into childcare. I understand that I may be contacted via cell phone if I am needed by my child(ren) (for a diaper change, consoling, etc). I agree to monitor my cell phone for such messages and arrive promptly should this occur.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
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's Age REQUIRED Please fill out this field. Please enter valid data.
- Any medical or food allergies? Please enter valid data.
- Medical Release for Childcare
  
  As parent and/or legal guardian I remain legally responsible for any personal actions taken by the above-named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Catholic Diocese of Richmond, the Church of the Holy Family, their employees and agents, chaperones, or representatives associated with the event from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese and/or Church of the Holy Family, their employees and agents and chaperones, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese and/or Church of the Holy Family.
  
  I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. I hereby give permission to Church of the Holy Family to contact emergency services for the transportation of my child(ren) to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above number(s), I give permission for the noted emergency contact to be notified. I will not hold the Diocese of Richmond and/or the Church of the Holy Family responsible for authorizing any medical treatment beyond necessary transportation to the hospital.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
- Proximity Agreement for Childcare
  
  I agree to remain on the premises of Church of the Holy Family while my child(ren) is (are) signed into childcare. I understand that I may be contacted via cell phone if I am needed by my child(ren) (for a diaper change, consoling, etc). I agree to monitor my cell phone for such messages and arrive promptly should this occur.
  
  Valid through April 27, 2024
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.

Payment

One time workbook fee per couple20.0

Marriage and Family Ministry - Enrichment Series

Date: Sundays: 1/12, 2/2, 2/23, 3/16, 4/6, 4/27

Time: 12:30-2:00pm

Location: Church of the Holy Family

Register

Couple Information

Childcare

Medical Release for Childcare

Proximity Agreement for Childcare

Medical Release for Childcare

Proximity Agreement for Childcare

Medical Release for Childcare

Proximity Agreement for Childcare

Medical Release for Childcare

Proximity Agreement for Childcare

Medical Release for Childcare

Proximity Agreement for Childcare

Medical Release for Childcare

Proximity Agreement for Childcare

Medical Release for Childcare

Proximity Agreement for Childcare

Payment