Good Shepherd Catholic Church

Religious Education Registration Date: ______

2016-2017

Family Name: Child’s Last Name if different

______/______

Address: ______

City State Zip

E-Mail: ______Home Phone: ______

Father: ______Cell or WorkPhone: ______

Mother: ______Cell or Work Phone: ______

PLEASE CHECK WHICH SACRAMENTS YOUR CHILD(REN) HAS RECEIVED.

FOR SACRAMENTS RECEIVED AT GOOD SHEPHERD, PLEASE CHECK INSIDE THE AT “G.S.” BOX.

FOR SACRAMENTS RECEIVED AT OTHER PARISHES, PLEASE CHECK BOX TO THE LEFT OF

“at G.S.” BOX.

Name of Child(children) / Date of Birth / Sex / School
Grade
016/17 / Baptism at G.S / Reconciliation at G.S. / Eucharist at G.S. / Conf.
at G.S / Years of Previous Religious Education

IF YOUR CHILD (CHILDREN) WAS BAPTIZED AT A PARISH OTHER THAN GOOD SHEPHERD WE ASK THAT YOU PROVIDE A COPY OF THEIR BAPTISMAL CERTIFICATE.

CLASS TIMES:

Sunday Morning: Pre-School (ages 3 & 4)9:45 to 11:15 a.m. Grades K-5: 9:45-11:15 a.m.

Sunday Evening: Grades 6-12: 6:00-7:30 p.m.

Registration Fee:Parishioners $35.00 per child/cap of $75.00 per family upon completion of form.

If you are not a registered parishioner: $50.00 fee per child.

FIRST RECONCILIATIONAND FIRST EUCHARIST PREPARATION:

Parents of children who are preparing to receive these sacraments are expected to attend weekly parent classes. These classes are held at the same time your child attends class. Please indicate below the name(s) of the parent/guardian who will be attending.

Name:______

CONFIRMATION PREPARATION:

Parentsof teens preparing for the Sacrament of Confirmation

PLEASE NOTE YOU WILL BE ASKED TO ATTEND CERTAIN SESSIONS OF THIS CLASS WITH YOUR CHILD. Please indicate below the name(s) of the parent/guardian who will be attending.

Name: ______

(OVER - PLEASE COMPLETE THE BACK OF THIS FORM)

SPECIAL HEALTH /SAFETY NEEDS:

PLEASE LIST BELOW THE NAME OF ANY CHILD WHO REQUIRES SPECIAL HEALTH, SAFETY OR EDUCATIONAL CONSIDERATIONS SUCH AS MEDICATION, HISTORY OF SEIZURES, ALLERGIES, LEARNING DISABILITIES, ETC.

NAME OF CHILD / SPECIAL HEALTH /SAFETY NEEDS

EMERGENCY CONTACT (OTHER THAN PARENTS/GUARDIANS):

Name: ______Phone #: ______Relationship: ______

MEDICAL INFORMATION/RELEASE:

As parent/guardian, I certify that the registered children on the reverse of this form have health/accidental/medical insurance coverage as follows: Name of Company: ______

Policy #: ______

GOOD SHEPHERD AND THE DIOCESE OF RALEIGH ARE NOT RESPONSIBLE BEYOND THE LIMITS OF YOUR COVERAGE.

As parent/guardian, I certify that I understand if my children have no health/accident/medical insurance coverage, my signature on this form assures the church that I will be responsible for the payment in full of all expenses which may occur due to illness or injury relative to any Religious Education Program activity in which my children participate. As parent/guardian, I give my permission to the Adult Advisors or their designees to request usual and customary medical/safety services for my children if needed at any Religious Education Program activity in which my children participate with the understanding that I will cover all such emergency costs not covered by my insurance.

PHOTO PERMISSION: Please initial one of the following

____ YES - As parent/guardian, I understand that pictures (individual and group) will be taken during all parish events. I give permission for my son’s/daughter’s picture to be used for parish activities and materials (newsletter, web page & social media, calendars, power point, etc.) in highlighting the event.

____ NO - As parent/guardian, I do not give permission for my child to be photographed or video-taped.

PARENT/GUARDIAN SIGNATURE: ______Date: ______

Please take part in the following questions in order for our Parish to assist you:

Are you a registered member of our Parish? Yes No

Do you attend Sunday Mass weekly as a family? Yes No

If no would like to talk with someone? Yes No

Are you a military family that would benefit with help from our parish during deployments?

If yes would you like to be contacted or talk with someone? Yes No

Would you be interested in helping with the Religious Education Program? Yes No

Are you interested in Adult Faith Formation? Yes No

If so what you be most interested in: (Please circle your interests) Bible Study / Small Christian Community (Small Group) /Catholic Book Club / “Catholicism” – A monthly video Series of our faith about the development of the Catholic Church and Sacraments by Fr. Robert Baron / RCIA

Would you be comfortable with us contacting you when any of these programs are scheduled? Yes No