Totus Tuus Participant Registration Form

Please fill out the following information to register for Totus Tuus. (Please note: registration is not required for Evening Sessions.) Totus Tuus will be hosted at St. Anthony Parish in O'Malley Hall. The Totus Tuus Day sessions are Monday - Friday, June 13-17 from 9:00 AM - 2:30 PM. The Day sessions are for students entering grades 1-6 in the 2016-2017 school year. Totus Tuus is open to all parishes in Dubuque. Please contact the Faith Formation Office with any questions at 563-582-0377.

The fee for the Totus Tuus Day Program is $35. (The Totus Tuus Evening Program accepts free will donations.) You may pay by check or online. If paying by check, please submit payment for Totus Tuus to St. Anthony Parish, 1870 St. Ambrose St., Dubuque, IA 52001. There are optional Totus Tuus t-shirts available at a cost of $15. These may be purchased online or by calling (563)582-0377. There will also be t-shirts available for purchase during the week of Totus Tuus.

Snacks and drinks will be provided, but students must bring a sack lunch.

* Required.

Parent/Guardian Information

Emergency Contact Information

Family Medical Information

Required Permissions

The following require a "yes" or "no" response.
This Consent and Liability waiver is required for your child(ren) to participate in Totus Tuus which is being hosted at St. Anthony Parish, 1870 St. Ambrose St., Dubuque, IA 52001.
Program Coordinator: Stephanie Klapatauskas, 563-582-0377.

Consent Form and Liability Waiver

Emergency Medical Treatment

Illness Notification

Non-prescription Medication Permission

Allergy Information

Asthma Information

Prescribed Diet Information

Physical Limitations Information

Other Medical Information

Media Release and Authorization

Electronic Signature

This is a binding electronic signature.

Child 1 Information

Child 2 Information

Child 3 Information

Child 4 Information

Administration of Medication - Archdiocesan Faith Formation Commission Policy 5141, items 9.2, 9.3, 9.4, & 10
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.

Volunteer Information

You may also visit the Totus Tuus Adult Volunteer Registration Form for more information if you wish.