2017-2018 School Year Religious Education Registration - Part 1

Religious Education Registration Form

Please fill out the following information to enroll for Religious Education Classes for 2017-2018 school year. Classes are Wednesday evenings from 6:30pm-7:45pm for K-6th grade and 6:30pm-8:00pm for 7th-High School. Please contact the Faith Formation Office with any questions at 563-582-0377.

The fee for students in Religious Education is $190 for one child, $360 for two, $510 for three, and $640 for four or more children.

2nd Grade and 10th Grade RE/Confirmation will also have a $40 Sacramental Preparation Fee added to their tuition.

*Confirmation takes place in 10th grade*

Sacramental Preparation Fee for Holy Family Students in Grades 2 and Confirmation is $40

If you register and pay in full by June 15th, 2017 there is a $25 per family discount. Catechists and Aides also receive $25 off!

Family Information


Parent/Guardian Information

xxx-xxx-xxx

xxx-xxx-xxx

Non-Custodial Parent Information (If applicable)

Dual Parent Reporting
Archdiocesan Policy #5124 states, “Unless otherwise decreed in the Order of Dissolution, information commonly made available to parents of any student in attendance (i.e., notices of school/catechetical program functions, report cards, appointments for parent-teacher conferences) should be provided to both parents.”

In a situation where parents are separated the following information must be filled out AND an additional form needs to be turned into the RE Office. The Form can be downloaded from the website -Dual Consent Reporting - Policy 5124


Emergency Contact Information

Family Medical Information

xxx-xxx-xxx

Parent/Guardian Volunteer Opportunities

Your contribution of time and talent is crucial to the success of our program. Opportunities for your involvement are listed below. All volunteers make a difference for our kids. Help make a difference in your child's religious education!

Required Permissions

The following require a "Yes" or "No" response for each of the required permissions.

Consent and Liability Waiver

EMERGENCY MEDICAL TREATMENT PERMISSION

ILLNESS NOTIFICATION

NONPRESCRIPTION MEDICATION PERMISSION

ALLERGY INFORMATION

ASTHMA INFORMATION

PRESCRIBED DIET INFORMATION

PHYSICAL LIMITATIONS INFORMATION

OTHER MEDICAL INFORMATION

Learning Difficulty Information

Special Education Information

Administration of Medicine-- Archdiocesan Board of Education Policy 5141, items 9-10.

Administration of Medication
9. Dispensing of prescription medication
1. For Catholic schools - Dispensing of prescription medication will be administered by a nurse or designated party with training and with the written consent of parent(s)/guardian(s). Prescription medication must be provided to the school in the original labeled container containing the physician’s name, name of the medication, and dosage/frequency to be given. A record of each dose of medication administered will be documented in the pupil’s health record.
2. For all other youth programs - Dispensing of prescription medication will be self-administered by the child if a written consent of parent(s)/guardian(s) accompanies the prescription medication and the following terms are followed. The prescription medication is provided in the original labeled container containing the physician’s name, name of the medication, and dosage/frequency to be given; the prescription medication is turned into the event supervisor who will hold all medication until the child/youth requests the medication for self-administration, the prescription medication is self-administered in the presence of the adult supervisor and for only the dosage stated on the prescription label.
3. Students utilizing asthma or airway constricting prescription medication are allowed to administer their own dosage provided a completed consent form is on file in the school/program office. Such forms must be filed annually.
4. Contraceptives will not be dispensed. Iowa Code §280.16
10. Dispensing of nonprescription medication may occur, provided the parent/guardian have signed and dated an authorization identifying medication, dosage, and time interval to be administered. Nonprescription medications can be provided on off-site field trips if the parent/guardian signs a nonprescription medication authorization for each off-site field trip.

To better help our students please state any other pertinent information that a catechists should know. (Example-if your child is on medication during the day, but is not on it during the evening class time.)


MEDIA RELEASE AND AUTHORIZATION

PARTICIPANT INFORMATION RELEASE

Parent/Guardian Obligations

Electronic Signature

This is a binding electronic signature

 
 

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