OUR LADY OF LORETTO RELIGIOUS EDUCATION

Registration for Grades 1-12

2015-2016

Return to the Religious Education Office,1806 Novato Blvd., Novato, CA 94947 by August 15, 2015

Child(ren’s) LAST Name: / Home Phone:
Address: / Zip:
Father’s Full Name: / Work Phone:
E-Mail: / Cell Phone:
Mother’s Full Name: / Work Phone:
Mother’s Maiden Name: (Required)
E-Mail: / Cell Phone:
Emergency Contact Name: / Phone:
Child’s First Name / Gender / Grade:
Fall 2015 / School:
Fall 2015 / Has child been
Baptized:
Yes or No / Has child made First
Communion:
Yes or No / Date of Birth

Is your child making his/her First Reconciliation/First Communion/or Confirmation this year? If your child was not baptized at Our Lady of Loretto, you must provide a copy of his/her Baptismal Certificate. If you do not have one, you may obtain one by calling or writing the Church of Baptism and requesting a copy. Please submit it to Our Lady of Loretto Religious Education Office. Certificates need to be received no later than November 1, 2015.

Church of Baptism / Address – Street, City, State/Country, Zip / Date of Baptism
Child 1
Child 2
Child 3

See reverse for schedule of classes for the 2015-2016 program.

We encourage you to submit the tuition and fees in a timely manner. Please contact the Religious Education Office if you need tuition/fee assistance. Please make checks payable to Our Lady of Loretto RE – 1806 Novato Blvd., Novato, CA 94947

Basic Tuition / One Child / $175
Two Children / $225
Three or More / $250
Sacramental Fee (paid for First Reconciliation,
First Communion, or Confirmation year only) / Per Child / $75
Early registration discount if received by 8/15/15 / ($25)
Total Tuition and Fees:

OFFICE USE ONLY:

Tuition Due: / Pd: / Date: / Pd: / Date: / Pd: / Date:
Fees Due: / Pd: / Date: / Pd: / Date: / Pd: / Date:

Please complete reverse side

OUR LADY OF LORETTO RELIGIOUS EDUCATION

2015 – 2016 Program

SCHEDULE OF CLASSES

TRANSPORTATION

Please indicate below if someone other than the parent or guardian (signed below) will be responsible for picking up your child/children after the Religious Education Classes:

Name:______Phone:______

No skateboards are allowed as a means of transportation. Will your child be allowed to walk or ride a bike to and from class: Yes______No______

EMERGENCY MEDICAL RELEASE

The following is a release to provide Medical Care in the case of an emergency, such as an earthquake, or if your child becomes ill or is injured. Your child will not be left alone during an emergency situation. You will be contacted as soon as possible.

Family Physician: / Phone:
Address: / City/Zip
Medical Plan: / Plan No:
If you do not want medical care given to your child, please state the reason:

HOLD HARMLESS AGREEMENT

I/We agree that in the event my/our child is injured as a result of his/her participation in religious education activities, including transportation to and from these activities, whether or not caused by negligence of the parish/school Religious Education/Youth Ministry program or any of its agents or employees, recourse for the payment of resulting hospital, medical or related costs and expense will be first paid for and covered by any accident, hospital or medical insurance, or any other available benefit or mine/ours.

Parent/Guardians Signature: ______

Telephone No.: ______

Date: ______