Guardian Angels Parish School of Religion (C

YOU MUST BE AN ACTIVE GUARDIAN ANGELS, OR ST. JEROME PARISHIONER

TO ATTEND CCD AT GUARDIAN ANGELS

GUARDIAN ANGELS PARISH SCHOOL OF RELIGION (C.C.D.) PROGRAM

6531 BEECHMONT AVENUE

CINCINNATI, OHIO 45230

ELEMENTARY REGISTRATION FORM

2017-2018 SCHOOL YEAR

624-2195

First Night of CCD will be September 13, 2017

CHILD'S FULL NAME______

FIRSTNAME (GOES BY NAME) MIDDLE NAME LAST NAME CHILD’S GENDER______CHILD’S DATE OF BIRTH______

FATHER'S NAME______RELIGION______

MOTHER'S NAME______RELIGION______

ADDRESS______ZIP______PHONE______

E-MAIL ADDRESS______

WAS YOUR CHILD REGISTERED IN GUARDIAN ANGELS CCD PROGRAM LAST YEAR?______

GRADE STUDENT WILL BE IN THIS FALL (SEPT. 2017) CIRCLE: K 1 2 3 4 5 6 7 8

DAY SCHOOL, STUDENT ATTENDS______

ARE YOU AN ACTIVE MEMBER OF GUARDIAN ANGELS?______(IF NO, PARISH) ______

(Will be verified)

CHILD LIVES WITH: (Please Check All That Apply)

[ ] FATHER [ ] MOTHER [ ] FATHER & STEP-MOTHER [step-parent’s name:______]

[ ] MOTHER & STEP-FATHER [step-parent’s name: ______]

[ ] OTHER [Please specify relationship______]

SACRAMENTAL INFORMATION (Must be completed for Registration to be processed)

BAPTISM: YES_____NO____ CHURCH NAME, STREET ADDRESS______

CITY, STATE & ZIP______

1st COMMUNION: YES______NO______PENANCE: YES______NO______

CHURCH______

CITY, STATE & Z IP______

CONFIRMATION: YES______NO______CHURCH ______

CITY, STATE & ZIP ______

SACRAMENTAL PREPARATION

IMPORTANT! We need baptismal certificates for 2nd graders and 7th graders who were not baptized at Guardian Angels Church. Please send or bring a copy of the Baptismal Certificate to the Religious Education Office, at the time of registration. (We will copy an original certificate and return it to you if needed.)

If you have previously attended Guardian Angels day school, we do not have access to your baptismal certificate. Therefore, if you were not baptized at Guardian Angels Church, you will need to provide us with a copy of your certificate.

Parents, please note:

As per Archdiocesan regulations, children must have one full year of catechesis prior to the year in which they expect to celebrate a sacrament.

STATEMENT OF COMMITMENT

I/We will assume our responsibilities as parents/guardians to attend Mass and to make certain that our child/ren attend Mass. I/We will be committed to making the Catholic faith part of the daily life and decision-making of our family.

PERMISSION AND RELEASE FORM

I/We, the parent(s)/ guardians(s) of ______(the "child"), give permission for my child to participate in Guardian Angels Parish School of Religion Program. I/We release from all liability and indemnify the Archbishop of Cincinnati (the "Archbishop"), both individually and as trustee for the Archdiocese of Cincinnati and all parishes within the Archdiocese, and their officers, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost or expenses, including attorney fees, arising out of injury or illness incurred by my child while participating in or traveling to or from the activity.

I /We agree to instruct my/our child to cooperate with the Archbishop or his agents in charge of the activity.

Parent(s)/Guardian(s) Signature(s)______

______

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PARISH SCHOOL OF RELIGION FEES

Registration is due on, or before August 1st, to allow time for verification. After August 1st, there will be a late fee charge, in the amount of $10.00. There is also no guarantee that there will be an opening for your child(ren), if registration is received after August 1st, 2017.

Active Parishioner Registration Fee: [There is an additional $15 fee for Sacramental years - grade 2, First Communion and grade 7, Confirmation prep. This covers the fee for the additional materials].

Fee for 1 child: $135.00 ($150.00 for grades 2 and 7)

Fee for 2 children: $195.00 ($210.00 for grades 2 and 7)

Fee for 3 + children: $215.00 ($230.00 for grades 2 and 7)

An Active Parishioner is one who regularly worships at Guardian Angels Parish and contributes weekly or, monthly using church envelopes. If you are not registered in the parish, you must do so before your registration will be accepted.

PLEASE SEND REGISTRATION, TUITION PAYMENTS AND EMERGENCY INFORMATION FORM(S) TO:

GUARDIAN ANGELS RELIGIOUS EDUCATION

PARISH SCHOOL OF RELIGION (C.C.D.) PROGRAM

6539 BEECHMONT AVENUE

CINCINNATI, OHIO 45230

If you have difficulty in paying the registration fee, please call the Religious Education Office (624-2195), so that we may schedule an appointment to have you fill out a Tuition Payment Intention Form.

Classes will begin on September 13th, 2017 at 7:00p.m.

The parent handbook will be sent home with your child, on the first night of CCD!

EMERGENCY INFORMATION

Student’s Last Name ______First Name ______Date of Birth ______

Family Name ______Emergency/Evening Phone ______

Mother’s Name ______Business Name/Address ______

Business Telephone ______Cell Number ______

Father’s Name ______Business Name/Address ______

Business Telephone ______Cell Number ______

List below,names and telephone numbers, of people who should be contacted when you cannot be reached. They should be able to pick your child up from C.C.D. in the event of illness. These people should be aware that they are on this list and have your permission to take this child home.

Name______Phone ______

************************************************************************************HEALTH AND LEARNING INFORMATION

DOES YOUR CHILD HAVE ANY HEALTH OR LEARNING PROBLEMS THAT THE TEACHER SHOULD KNOW ABOUT?

YES______NO______

DESCRIBE BRIEFLY______

______

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PHOTO RELEASE

I give my permission and consent for my son/daughter to participate in all photographs, videotapes, likeness of image or interviews to be taken during Parish Religion Programs. I further give my permission and consent for any such photographs, videotapes, likeness of image or interviews to be published and used to illustrate, promote and advertise our Parish Religious Programs including but not limited to use on Internet GA Web sites.

Date ______Signature of Parent or Guardian______

I do not give my permission and consent for my son/daughter to participate in all photographs, videotapes, likeness of image or interviews to be taken during Parish Religion Programs.

Date ______Signature of Parent or Guardian______

MEDICAL AUTHORIZATION FORM

Purpose – To enable parents and guardians to authorize the provision of emergency treatment for children who become ill or injured under parish authority, when parents or guardians cannot be reached.

PART I OR PART II MUST BE COMPLETED. Please Print Information and Sign Part I or Part II

PART I TO GRANT CONSENT

In the event reasonable attempts to contact me at ______(phone) or ______

(other parent or guardian) at ______(phone) have been unsuccessful, I hereby give my consent for:

1) the administration of any treatment deemed necessary by Dr. ______(preferred physician) at

______(phone) or, Dr. ______(preferred dentist) at ______

(phone) or, in the event the designated preferred practitioner is not available, by another licensed physician

or dentist; and

2) the transfer of the child to ______(preferred hospital) or any hospital reasonably

accessible.

Medical Information for Your Child

Allergies ______

Medications______

Chronic Conditions (e.g. epilepsy, diabetes) ______

Medical Insurance Company ______

Policy Number______Member's Name______

This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained before surgery is performed.

______

Date Signature of Parent or Guardian

(DO NOT COMPLETE PART II IF YOU COMPLETED PART I)

PART II REFUSAL TO CONSENT

I DO NOT give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the school authorities to take no action:

______

Date Signature of Parent or Guardian