ST. PATRICK’S PARISH COMMUNITY
Confidential Registration for Faith Formation 2017-2018
Father/Stepfather/Guardian (circle one)Name______
Address______
(If PO Box, please include Street)CityZip
Home# ______Work # ______Cell# ______E-mail______
Mother/Stepmother/Guardian (circle one)Name______
Address______
(If PO Box, please include Street)CityZip
Home# ______Work# ______Cell# ______E-mail______
Contact in case of an emergency: Name______Phone # ______
NAME OF STUDENTS:(oldest to youngest)Please include Last Name if different from Father/Mother/Step/Guardian
If this is your child’s FIRST time registering
(As of Sept 2017)please check those Sacraments received.
Also, please supply one copy of each child’s
baptismal certificate.
NAME GRADEBIRTHDATE Baptism Reconciliation Eucharist Confirmation
Please check if interested in Xtreme Faith Choir □Name:______
Open to all youth grades 7th-12th!!! All are welcome to participate!
Volunteers – Please select an area if you are interested in assisting– THANK YOU!
Catechist___Asst. Catechist___Substitute___Child Care___Driving students to special events___
Assist with Retreats___ Prepare snacks/ meals beforeFaith Formation Classes/Retreats___ Assist with TotusTuus___
Xtreme Faith Choir Asst. ___ Music/Musicians ____ Hall Monitors ___ Greeters___ Assist with Allelu____
EMERGENCY FORM
Student NameAgeAllergies
______
______
______
______
Additional information that we need to know about your child to be of help to him/her for example, learning disabilities, allergies, physical disabilities, medical problems, etc.
______
______
In the event that the undersigned, or my emergency contact, cannot be reached and in the judgement of the Director of Religious Education or other person responsible for program/group, or other appropriate staff member, there is a necessity for immediate examination and /or treatment of my child, I (we) hereby authorize any of the aforesaid personnel to obtain for my (our) child such medical services as are deemed necessary. I agree to assume the financial responsibility for any diagnosis/treatment and for medication deemed necessary.
Dates for which release is intended: September 6,2017 to April 18, 2018.
*Signature of Parent/Guardian______Date ______
Photo Permission Form
The activities of the Faith Formation Program are published on the St. Patrick’s website and Facebook. Although much of the information will be in word form, photos and other graphics will be an important part of our electronic publication. So, we need your permission to include photos of your child on the site. Know that we will follow suggested safety and privacy guidelines. No names or personal information will ever be posted on the St. Patrick’s website or Facebook. Unless other written instruction is submitted, I also consent to allowing my child/children’s image to be used during or after Faith Formation for Diocesan publication use: parish bulletin, the West Nebraska Register, or future advertisement of parish programs and/other social media.
Effective September 6, 2017 to April 18, 2018.
Yes, I grant permission for St. Patrick’s Faith Formation Program to publish my child’s photograph on the Parish website/Facebook for school year of 2017-2018.
No, I would prefer that my child’s image not be published on a website/Facebook at this time.
*Signature of Parent/Guardian ______Date ______