ST. joan of arc parish religious education form: 2015-2016 student information: name of student



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ST. JOAN OF ARC PARISH

RELIGIOUS EDUCATION FORM: 2015-2016
STUDENT INFORMATION:
NAME OF STUDENT:________________________________________________________________________

(First) (Middle) (Last)



ADDRESS”_________________________________________________________________________________

(Street) (City/State) (Zip)



E-mail address for Religious Education communication: _________________________________________

Phone where parents can be reached during RE time: ____________________ Home/Primary Phone: __________________

Student’s Birthdate: ______________ Birthplace:____________________________ Gender: M____ F_____

School:_____________________________________________ Grade as of September 2015? __________

New student? ___Yes ___No Transfer from another parish? ___Yes ___No If yes, name of parish: ____________________

Did this student attend Religious Education classes in 2014-2015? ___Yes ___No If so, what grade?_____

Is this student returning to Religious Education after a break of one or more years? ___Yes ___No

If yes, what was the last year and grade in which the student was enrolled? Grade_____ Year______



Has your child been baptized? Yes_______



No______

Date/Parish___________________________

Has your child received First Reconciliation? Yes_______



No______

Date/Parish___________________________

Has your child received First Communion? Yes_______



No______

Date/Parish___________________________


If your child received these sacraments at St. Joan of Arc, we have the information on file; if your child received any of these sacraments at another parish, please provide us with a copy of the sacramental certificate. THANKS SO MUCH.

FAMILY INFORMATION:

Does your child live with: Both Parents?______ Mother only?______ Father only?_______

If not parents, with whom? (Name and Relationship) ________________________________________________________

MOTHER’S NAME_____________________________________________ Catholic? Yes: __ No___

Married?___ Single?___ Divorced?___ Remarried?___ Widowed?_____

FATHER’S NAME_____________________________________________ Catholic? Yes___ No___



Married?___ Single?___ Divorced?___ Remarried?___ Widowed?_____

Are you registered in the Parish? Yes___ No___ If no, do you want to register? Yes___ No___

TUITION: Parishioners: $260.00/1 child, $415/2 children, $560/3 children, $680/4 children

Non-Parishioners: $350/1child, $560/2 children, $755/3 children, $915/4 children

Payment Options: Total payment now: _____ Monthly: ____ Bi-Monthly: ____ Other: _____ (specify below)

SAINT JOAN OF ARC

Religious Education Registration: 2015-2016 Page Two:

Student’s Name:_______________________________________

Allergies or medical needs?_____________________________________________________

Special needs or learning differences?____________________________________________

____________________________________________________________________________

EMERGENCY INFORMATION

The emergency number you give us must be different than the home or parents’ phone numbers and must be someone who can be reached during class time. We will always call the family contact numbers first, but if we can’t reach parents, the person below will be contacted:

Emergency Contact Person: _________________________________ Phone number: _________________

Relationship to the child or family: ___________________________________

MEDICAL RELEASE:

In the event that I, as the undersigned parent/guardian of this child, cannot be contacted,, and in the judgment of the Director of Religious Education (or the Pastor or other supervising staff or volunteer) my child requires immediate medical intervention, I hereby request and authorize the DRE or other supervising personnel to obtain for my child such medical services as are deemed necessary. I agree to assume financial responsibility for any diagnosis/treatment and for any medication deemed necessary.

Dates for which this release is intended: September 1, 2015-May 31, 2016:

Parent/Guardian Signature:_____________________________ _____ Date___________________

PHOTO/VIDEO/CLASSROOM WORK PERMISSION FORM:

On occasion, the Parish or St. Joan of Arc Religious Education Program may use photos, videos and/or classroom art or written work of students in parish publications to share information about the parish. Publications include, but are not limited to: the website, parish bulletins, annual reports, newsletters, posters, advertisements and other public relations material. In addition, local news organizations may hear of our activities or events, and our parish may invite or allow them to photograph or record our events. Names of students will NOT be released.

Please sign and check below:

_____My child’s photo, video or classroom work may be published in any format including group or individual photos.

_____My child’s photo, video or classroom work may NOT be published in any format including group or individual



. Photos.

Parent/Guardian Signature:_____________________________ _____ Date___________________


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