2021-2022 School Year Religious Education Registration - Part 1

Please fill out the following information to enroll for Religious Education Classes for 2021-22 school year.  Classes are Sunday mornings from 9:30am-10:20am for K-8th grade and Wednesday evenings at 7:00pm-8:00pm for 9th-10th.  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 Sacraments and 10th Grade Confirmation will also have a $40 Sacramental Preparation Fee added to their tuition.

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

Catechists and Aides also receive $25 off!

Please email Jen Even [email protected] or Marcy McElroy [email protected] with any questions. 

 

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

Administration of Medication Archdiocesan Catholic School Board Policy 5141, items 9-10.

Administration of Medication
Archdiocesan Catholic School Board Policy 5141, items 9-10. (For Catholic School
programs only)
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. 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.
3. 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

Electronic Signature

This is a binding electronic signature

 
 

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