St. Anne Catholicchurch

St. Anne CatholicChurch

K-8 Religious Education ProgramRegistrationForm2017-2018

Student Information

Child’s Name: (first,middle,last) ______

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Sacraments Received:

□Baptism Where?______□Reconciliation(Confession)

□Holy Communion □Confirmation

Date of Birth:______/_____/______Grade of Child:K12345678 Grade forReligious Education:______Sex: M F

EthnicBackground______

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Child’s Name: (first,middle,last) ______

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Sacraments Received:

□Baptism Where? ______□Reconciliation(Confession)

□Holy Communion □Confirmation

Date of Birth:______/_____/______Grade of Child:K12345678 Grade forReligious Education:______Sex: M F

EthnicBackground______

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Child’s Name: (first,middle,last) ______

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Sacraments Received:

□Baptism Where?______□Reconciliation(Confession)

□Holy Communion □Confirmation

Date of Birth:______/_____/______Grade of Child:K12345678 Grade forReligious Education:______Sex: M F

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Family Information

Father’s Name:______Religion:______

Mother’s Name:______Religion:______

LegalGuardian:______

ContactInfo:

Name:______

Street:______City:______Zip:______

Home Phone:______Mom’sCell:______Dad’s Cell:______

Email Address: ______

AreyouRegisteredParishionersofSt.AnneChurch?YesNo

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Medical/ EmergencyInformation

NameofChild#1______

Medical,EnvironmentalFoodAllergies ______

SignificantMedicalHistory______

NameofChild#2______

Medical,EnvironmentalFoodAllergies ______

SignificantMedicalHistory______

NameofChild#3______

Medical,EnvironmentalFoodAllergies ______

SignificantMedicalHistory______

NameofPhysician:______

Phone:______

Address: ______

MedicalInsuranceCompany: ______

Insurance Number:______

Othercontactincaseofanemergency:

Name:______Home Phone:______

Relationship:______CellPhone:______

MedicalRelease

In the event that the undersigned,or my (our) authorized physician, cannot be reachedand in the judgment of Piper Grazulis, Coordinator of Religious Education, or appropriate staff member,it seems necessaryforimmediate medical examinationand/or treatment of my(our)child,such medical services as are deemednecessary.I agree to assume the financial responsibility for any

diagnosis / treatment andformedicationdeemed necessary.

Datesforwhichthisreleaseisintended:September10,2017~May 6,2018.

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Parent/Guardian Signature:______

Date:______

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Tuition Information:

$60 per student/ Totalfor this family$ ______($70ifregisteredafterFriday,Sept2nd)

Paid$______Balance due $______

Volunteers

Please indicate if you will consider working with us in one of the following ways:

_____ Chaperone Mass as needed

_____ Furnish supplies / or snacks as needed

_____ Become a catechist

_____ Help at a sacrament Mass

Schedule

*New* This year’s Religious Education classes will be meeting on Sunday’s from 9:00am – 10:15am followed by 10:30am mass. There will be volunteers to chaperone your children at Mass should you be unable to attend. REGULAR MASS ATTENDANCE IS STRONGLY ENCOURAGED by both parents and children.

ToParentsof2ndgraders:

Youwillbe receivinginformationvia e-mailregarding your child’spreparationfor the Sacramentsof FirstReconciliation andFirst Holy Communion.Welook forwardtotheseCelebrationswith your family this year.

ToParentsof7thand8thgraders:

Nextyear your sonordaughterwillbereceivingthe Sacramentof Confirmation! Expect more information later!

ToallParents:

Pleasedo nothesitate tocontactme withquestions,concernsor comments815-631-4446 or .I look forward to workingwitheachoneofyouas we striveto assist thechildreninunderstanding theirfaith andloving our God!

St.Anne,Prayforus!

Piper Grazulis,CoordinatorofReligiousEducation

PHOTO PERMISSION SLIP

From time to time we take pictures during ______activities. We would like [name of parish or school or ministry]

your permission to use these pictures…

______on our website,
______on the official Facebook page,
______in our newsletter

______on our bulletin boards

______in the parish bulletin

______other ______

Pictures are selected to highlight activities at our parish/school. We will never reference your child by full name or provide specific information regarding your child.

Please take a moment to let us know your preferences regarding our use of photos of your children:

_____YES. I grant permission to use photos of my child in the ways I’ve indicated above with an X.

-OR-

_____ NO. Please do NOT take or use any photos of my child.

Child(ren)’s Name(s) (PLEASE PRINT):

______

Parent/Guardian’s Name (PLEASE PRINT):

______

Parent/Guardian’s Signature:

______

Date: ______

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