St. Stanislaus Kostka Church

A Roman Catholic Parish
1590 Main Street, Pleasant Valley, NY

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Free Time for Parents Registration

- Faith Formation

Child Care Registration Form: 12/13/2024
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- PARENT INFORMATION
- 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 TO CHILD REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- ADDITIONAL INFORMATION YOU WANT TO SHARE
- ALTERNATE EMERGENCY CONTACT (if desired)
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- RELATIONSHIP TO CHILD Please enter valid data.
- Phone Number Maximum 20 characters Please enter a phone number.
- CHILDREN PARTICIPATING
- CHILD 1
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- AGE Please enter an integer (number).
- Allergies Yes No
- If yes, what is your child allergic to? Please enter valid data.
- CHILD 2
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- AGE Please enter an integer (number).
- Allergies Yes No
- CHILD 3
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- AGE Please enter an integer (number).
- Allergies Yes No
- If yes, what is your child allergic to? Please enter valid data.
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