Religious Education Registration Form

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 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

This Consent and Liability waiver is required for and serves both on-site programs and off-site/field trip events/activities for the stated program year. I grant permission for my child to participate in parish/cluster events this year that may require transportation to a location away from the parish/cluster site. The activities will take place under the guidance and direction of parish/cluster employees and/or volunteers. As a parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor (“Participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend its officers, directors of the parish/cluster and agents, and the Archdiocese of Dubuque, chaperons, or representatives associated with the events, arising from or in connection with my child attending the events or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the parish/cluster, its officers, directors and agents, and the Archdiocese of Dubuque, chaperons, or representatives associated with the events for reasonable attorney’s fees and expenses which they may incur in any action I/we may bring against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/cluster or the Archdiocese of Dubuque.

EMERGENCY MEDICAL TREATMENT PERMISSION

I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me contact the emergency contacts/locations as listed in this online registration process.

ILLNESS NOTIFICATION

In the event it comes to the attention of the parish/cluster, its officers, directors and agents and the Archdiocese of Dubuque, chaperons, or representatives associated with any off-site activity or while at parish/cluster that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I wish to be notified.

NONPRESCRIPTION MEDICATION PERMISSION

I hereby grant permission for nonprescription medication (such as ibuprofen, Tylenol, throat lozenges, etc.) to be given to my child in the event a condition arises after my child is already in attendance at a parish/cluster program/activity.

SPECIFIC MEDICAL INFORMATION

LEARNING INFORMATION

MEDIA RELEASE AND AUTHORIZATION

PARTICIPANT INFORMATION RELEASE

Electronic Signature

This is a binding electronic signature