St. Mel Little Church Program

Welcome! This registration form is for our "Little Church" program for Kinder or Pre-Schoolers. Children must be age 3 to Kindergarten and potty trained. Volunteers cannot change diapers.

Registration will take approximately 5 minutes to complete. Once you submit your registration you will be redirected to our "Faith Direct" website for payment. We look forward to another amazing year sharing the richness of the Catholic faith with the children of our parish.

Parent or Guardian Information

Parent or Guardian Name *

Primary Contact Number *

Primary Contact Email *

SMS Optin

Opt-In to Receive SMS Text Notifications, Alerts & Occasional Marketing Communication.

Child's Information

Child's Full Name *

Child's Home Address *

City *

Postal code *

How old is your child? *

Is your child potty trained? *

Did your child attend Faith Formation (aka "Religious Education") classes last year? (2022-2023) *

Where did they attend Faith Formation last year? *

Is your family registered with St. Mel Parish? *

Has your child been baptized? *

Was the baptism in the Catholic Church? *

Child's Date of Baptism *

Child's Place of Baptism *

Please upload your child's Baptismal Certificate below. You may also submit this document at a later time if unavailable.

Upload Baptismal Certificate

Upload Document

Mother's Information

Mother's First Name *

Mother's Last Name *

Mother's Maiden Name *

Mother's Religion? *

Mother's Mobile Number

Mother's Email

Father's Information

Father's First Name *

Father's Last Name *

Father's Religion *

Father's Mobile Number

Father's Email

If a parent or guardian can't be reached in an emergency, please contact:

Name of Emergency Contact *

Emergency Contact Phone Number *

Relationship to Child (Emergency Contact) *

Support Our Ministry

Our wonderful Faith Formation catechists (teachers) are volunteers. We give them materials, training and support to share their faith in sessions (classes). Prayerfully consider the following: with support, guidance and training; how would you feel most comfortable supporting this ministry?

Select all that apply:

Medication Authorization and Permission

If my child needs to take medication while participating in this activity, I hereby give my child permission to self-administer his/her medication in accordance with the Medication Authorization and Permission Form, and, if my child cannot self-administer, I give permission to the responsible staff members or chaperones to administer or to assist in the administration of my child’s medication.

I also give permission to the responsible staff members, chaperones, medical practitioners and medical facilities to use their judgement in obtaining and providing medical treatment for my child should it become necessary to do so. I understand that health insurance benefits through the Location, if any, may have limited application, and that I am entirely responsible for the cost of all medical treatment provided to my child. I agree to reimburse the Location for the cost of any medical treatment and related expense incurred.

Release of Liability: As a condition of participating in this activity, I hereby hold harmless, release and discharge The Roman Catholic Archbishop of Los Angeles, a corporation sole, Archdiocese of Los Angeles Education & Welfare Corporation and the Location, their respective agents and employees and any parent / volunteer / chaperone, from any and all liability, loss or claims for personal injuries, wrongful death or property damage that I or my child may suffer as a result of participation in the activity described above.

Parental/Guardian Medication Authorization *

I Give Permission for Treatment

Parent/Guardian Release For Student or Minor (NonCommercial)

I understand and agree that my child's image, voice, name and/or work ("Personal Information") relating to the events or activities described above will be used for non-commercial purposes, including, but not limited to, publicity, exhibits, electronic media broadcasts or research. I understand and agree that my child's Personal Information may be copied, edited and distributed by the Location in publications, catalogues, brochures, books, yearbooks, magazines, exhibits, films, videotapes, CD's, DVD's, email messages, websites, or any other form now known or later developed ("Materials").

The Location may use the Personal Information at its sole discretion, with or without my child's name or with a fictitious name, and with accurate or fictitious biographical material. The Location will not use the Personal Information for improper purposes or in a manner inconsistent with the teachings of the Roman Catholic Church.

I waive any right to inspect or approve any materials that may be created using the Personal Information now and in the future. In exchange for the opportunity given to my child by the Location to participate in the activity, I agree that neither I, nor my child, will receive monetary compensation, royalties or credit. I understand and agree that the Location shall be the owner of all right, title and interest, including copyright, in the photographs, electronic recordings and Materials. If the Location intends to use the Materials for a commercial purpose, I will be provided at that time with information about the terms of the commercial use.

I hereby waive, release and forever discharge any and all claims, demands, or causes of action against the Location and its affiliated entities, employees, agents, contractors and any other person, organization, or entity assisting them with the photography, electronic recording or Materials, for damages or injuries in any way related to, or arising from the photography, electronic recordings or Materials, or the use of the Personal Information, and I expressly assume the risk of any resulting injury or damage.

I further understand and agree that this Authorization remains in effect until it is withdrawn in writing. I understand that if I change my mind about this Authorization, that I will submit another, new authorization form to the Location. However, my new authorization will not have the effect of revoking this Authorization, and the Location will have no duty or obligation to make any changes or alterations to any Materials that may have been prepared based on this Authorization.

I represent that I have read this Authorization, understand the contents and am able to grant the rights and waivers it contains. I understand that the terms of this Authorization are contractual and not mere recitals. I am signing this document freely and voluntarily.

I hereby authorize the Location to use the following personal information about my child: *

By signing this form below, I confirm that I have fully informed myself of the contents of this Little Church Registration form by reading it before I signed it. *

Clear

Would you like to register another child?

If YES, you will be redirected to a new child registration form to submit. If NO, you will be redirected to our "Faith Direct" website for payment. *

Yes