“Parish Religious Education is important for children because that is where they make their first connections between the Catholic faith and their identity as people called to that faith. It is where they first encounter, in a significant way, their companion members of the Body of Christ, and where they begin to understand what it means to belong to a community of believers. And it is where they begin to learn that God is bigger than – but at the same time deeply a part of – their own families. ”
Does my child need Religious Education by Larry Livingston; Liguori Publications, 2004

2020-2021 Religious Ed Calendar

Immaculate Conception Faith Formation Program Registration Form 2020-2021

I am registering my son/daughter for classes:

onlinein person

Fathers Full Name

Fathers Religion

Fathers Cell Phone #

Fathers Email Address

Mothers Full Name

Mothers Religion

Mothers Cell Phone #

Mothers Email Address

Home Address

City, State, Zip

Other/home phone #

Please list all persons living in your home.

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Emergency Contact

Emergency Contact Cell Phone #

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Dual Reporting

Please describe any requests regarding reporting to both parents in situations where the child does not reside with both parents.

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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.

YesNo

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2020-2021 Annual Parental/Guardian Consent Form and Liability Waiver - Valid through 8-31-2021

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

Please list the full names of each student you are registering.

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

Please check and sign the following

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.

Yes No

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.

Yes No

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.

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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

Date of Birth

Age

Grade

Gender

Male Female

What Sacraments has this student received?

BaptismReconciliationFirst Eucharist/First CommunionConfirmation

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

Student 2

First/Middle/Last Name

Date of Birth

Age

Grade

Gender

MaleFemale

What Sacraments has this student received?

BaptismReconciliationFirst Eucharist/First CommunionConfirmation

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

Student 3

First/Middle/Last Name

Date of Birth

Age

Grade

Gender

Male Female

What Sacraments has this student received?

BaptismReconciliationFirst Eucharist/First CommunionConfirmation

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

Student 4

First/Middle/Last Name

Date of Birth

Age

Grade

Gender

Male Female

What Sacraments has this student received?

BaptismReconciliationFirst Eucharist/First CommunionConfirmation

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

Student 5

First/Middle/Last Name

Date of Birth

Age

Grade

Gender

Male Female

What Sacraments has this student received?

BaptismReconciliationFirst Eucharist/First CommunionConfirmation

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

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