Faith Formation/Religious Education Registration

“Faith formation is more than a subject to be taught...

it is an invitation to a way of life."

Joe Paprocki

***When you have completed the online registration you will be redirected to "We Share" for online payment (labeled donation). Please choose Faith Formation Fees as your donation option. Fees are $75 per student + $60 sacramental fees for any 2nd or 10th graders receiving sacraments. You may opt out of online payment by closing out the browser once you have sumbitted your registration form. Payments can be made at any time by going to our main website and clicking the "donation" button and selecting Faith Formation Fees***

Faith Formation Program Registration

Fathers Full Name

Fathers Religion

Fathers Cell Phone #

Fathers Email Address

Mothers Full Name

Mothers Religion

Mothers Call Phone #

Mothers Email Address

Home Address

City, State, Zip

Other/home phone #

Please list all persons living in your home.

Emergency Contact

Emergency Contact Cell Phone #

Dual Reporting

Media Release and Authorization

I understand that by signing this Release and Authorization I hereby grant authority to Immaculate Conception Catholic Church for the use of any videos, photographs, or similar items in which my child/children might appear, or statements made by them, to be used on the parish website, parish bulletin, or parish social media. Note: no children's names will be published without prior consent.

Media Release and Authorization

Yes

2025-2026 Annual Parental/Guardian Consent Form and Liability Waiver - Valid through 9-31-2025

This Consent Form and Liability Waiver is required for and serves both on-site programs and off-site field trip events/activities for the stated program year. This form needs to be completed annually for each student(s). To obtain the needed permission, contact, emergency and medical information you are requested to supply the needed information. As the specifics of each off-site/field trip event are known you will be required to complete an Off-site/Field Trip Permission Form outlining the specifics of each activity. Please complete the following sections.

Section 1 - Contact Information

Section 2 - Off-site Field Trip Consent Form and Liability Waiver

Please check and sign the following

Section 2 - Off-site Field Trip Consent Form and Liability Waiver

I grant permission for my child(ren) to participate in school/parish events this year that may require transportation to a location away from the school/parish site. The activities will take place under the guidance and direction of school/parish employees and or volunteers of Immaculate Conception Parish. As a parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor(s)

Section 3 - Specific Medical Matters - Please check and complete the information requested.

I hereby warrant that to the best of my knowledge, my child(ren) is/are in good health, and I assume all responsibility for the health of my child(ren).

Emergency Medical Treatment

In the event of an emergency, I hereby give permission to transport my child(ren) 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 at the above numbers, contact the following:

Please list name of your family medical provider and phone #

Other Medical Treatment: In the event it comes to the attention of the parish/school, its officers, directors and agents, and the Archdiocese of Dubuque, chaperons, or representatives associated with the activity that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I want to be notified.

If yes, indicate the name and number of who should be notified

On-site Nonprescription Medication Permission - I hereby grant permission for nonprescription medication (such as ibuprofen, Tylenol, throat lozenges, etc.) to be given to my child(ren) in the event a condition arises after my child(ren) is/are already in attendance at the on site program.

Specific Medical Information: The parish/school will take reasonable care to see that the following information will be held in confidence. Please check/explain all that are applicable to your student(s) participant(s) - use the text box to explain.

Allergic reactions (medications, foods, plants, insects, etc.)

Has a medically prescribed diet?

Any physical limitations?

You should be aware of these special medical conditions of my child.

Please provide additional information applicable to each child.

Name of person completing these forms.

Date completed.

Individual Student Registration

Please complete the following for each student you are registering for Faith Formation/Religious Education classes.

Student 1

First/Middle/Last Name

Cell Phone #

Date of Birth

Age

Grade

Gender

What Sacraments has this student received?

Baptism

Reconciliation

First Eucharist/First Communion

Confirmation

Does this student have any learning difficulties, or are they involved in special education classes at their school?

Student 2

First/Middle/Last Name

Cell phone #

New Field:

Age

Grade

New Field:

What Sacraments has this student received?

Baptism

Reconciliation

First Eucharist/First Communion

New Option

Does this student have any learning difficulties, or are they involved in special education classes at their school?

Student 3

First/Middle/Last Name

Cell phone #

Date of Birth

Age

Grade

Gender

What Sacraments has this student received?

Baptism

Reconciliation

First Eucharist/First Communion

Confirmation

Does this student have any learning difficulties, or are they involved in special education classes at their school?

Student 4

First/Middle/Last Name

Cell phone #

Date of Birth

Age

Grade

Gender

What Sacraments has this student received?

Baptism

Reconciliation

First Eucharist/First Communion

Confirmation

Does this student have any learning difficulties, or are they involved in special education classes at their school?

Faith Formation Online Registration

“Faith formation is more than a subject to be taught...

it is an invitation to a way of life."

Joe Paprocki

Faith Formation Program Registration

106 Chapel Lane

Charles City, IA 50616

(641) 228-1071