BRITE Registration Form Family Last Name* Last Student's Full Name* First Last Phone*Home Address* Street Address Address Line 2 City ZIP Code Parent/Guardian InformationEmail Address* Enter Email Confirm Email Mother's Name* First Last PhoneMother's Alternate Number (work or cell)Father;s Name First Last PhoneFathers Alternate Number (work or cell)Student's gender*MaleFemaleStudent's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade in SchoolSchool attendingWhat is the primary language spoken at home?*Classes will meet every other week. Calendar will be distributed to families. Please select class schedule:*Grades K-8, Wednesday, 6:30-7:45 pmGrade 9 - Adult, Sunday, 4:00-5:00 pmCheck each sacrament received:* Baptism Reconciliation Eucharist Confirmation None received yet Diagnosis of developmental delay. Please be specific.*Check any that apply: uses wheelchair uses walker heightened sensitivity to sound non-verbal Date of last tetanus/diphtheria immunization/ booster*Primary Medical Insurance Company: include phone number, policy number and hospital preference you may have: **Family Physician Name and Phone Number*ANNUAL MEDICAL RELEASEI the undersigned parent or legal guardian of the above listed child, do give permission for a parish representative to transport my child to the nearest hospital or medical facility and to authorize emergency treatment. I will assume full responsibility.*YesNoPlease list special accommodations for student; including dietary restrictions and food allergies:What is the best learning environment for your child? (1:1 ratio, small group, use of maipulatives...)What additional information will help us meet the Religious Education needs for your child?Does your child attend Mass?*YesNoParent Commitment: Recognizing that I am the primary religious educator of my child, I commit to: Creating an atmosphere of prayer in my home; Regularly attending Mass on weekends and Holy Days of Obligation; Making Religious Education and Catholic practices a priority.*I do commit.I do not commit.ANNUAL ARCHDIOCESE MEDIA RELEASETo promote and chronicle activities, the Archdiocese of Atlanta and/or Transfiguration may record students (interviews, images, and/or video) for internal and external use. Content may be reprinted in The Georgia Bulletin or other media for public dissemination, including but not limited to film; video; television; radio; newspapers; websites and online platforms; and social media networks, including but not limited to Facebook, Twitter, and Instagram.*I do give permission for my child to be recorded.I do not give permission for my child to be recorded.ANNUAL SAFE ENVIRONMENT TRAINING PERMISSIONThe Archdiocese of Atlanta requires all students (kindergarten through grade 12) to participate in safe environment training. Children are taught that God is a loving, listening, caring presence in their daily lives and that they should feel secure and safe in sharing information with a trusted adult about problems or people that worry them. Sessions are age-appropriate and parents are welcome to attend. Dates / times will be published in the parish bulletin. For more information, visit the Religious Education page of our website.*I give permission for my child to attend the safe environment training.I do not give permission for my child to attend the safe environment training.Enter your name as the parent or legal guardian and your emergency phone number. (This is the equivalent of your signed authorization.)*Additional InformationPolicies, procedures and requirements are outlined in the Religious Education Handbook. It is the parent's or legal guardian's responsibility to obtain a copy and adhere to the policies in the handbook. Handbook is available, www.transfiguration.com/journey. After submitting registration, please go the Giving page, for tuition payment. ($25.) Thank you.Would you like an E-mail copy of the submission?*YesNoCAPTCHACommentsThis field is for validation purposes and should be left unchanged.