Religious Education Registration

Class Time REQUIRED Please fill out this field.

Child's Full Name REQUIRED Please fill out this field. Please enter valid data.

Birthdate REQUIRED Please fill out this field. Please enter valid data.

Age REQUIRED Please fill out this field. Please enter valid data.

City and State of Birth REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Please fill out this field. Please enter valid data.

Grade in School REQUIRED Please fill out this field. Please enter valid data.

Name of School REQUIRED Please fill out this field. Please enter valid data.

SACRAMENTAL INFORMATION

8th Grade Confirmation Students - Please Use the Confirmation Form to Register
Baptism REQUIRED Please fill out this field.
Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
City and State of Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
IMPORTANT
If the child has received First Penance, Eucharist or Confirmation. The church name, City and State MUST be included for records purposes.
Reconciliation REQUIRED Please fill out this field.
Reconciliation Location Please enter valid data.
Eucharist REQUIRED Please fill out this field.
First Communion Location Please enter valid data.
Confirmation REQUIRED Please fill out this field.
Confirmation Location Please enter valid data.

HEALTH HISTORY

Does your child have any physical, medical or other condition that will affect or be affected by participation in Religious Education Activities* REQUIRED NO (please proceed to disclosure statement A) YES (please proceed to disclosure statement B) Please fill out this field.
Disclosure Statement A
My Child has no physical, medical, or other condition that will affect or be affected by participation in Religious Education activities. Further, my child has no allergy that should be disclosed to emergency personnel.
Typing your name means, I agree with Disclosure Statement A, this child has NO physical, medical or other condition. REQUIRED Please fill out this field. Please enter valid data.
Disclosure Statement B
My child DOES have allergies that should be disclosed to emergency medical personnel or a physical, medical or other condition that will affect or be affected by participation in Religious Education Activities.
Typing your name means, I agree, my child DOES have allergies or a physical, medical or other condition. REQUIRED Please fill out this field.
PERMISSION FOR DISCLOSURE AND EMERGENCY MEDICAL TREATMENT
The parish has my permission, in an emergency when parents or guardians cannot be contacted, to take my child to a hospital emergency room. the hospital and its medical staff have my authorization to provide treatment that a physician deems necessary for the well-being of my child. I will be contacted as soon as possible and will be advised prior to any further treatment by the hospital or doctor. I understand and agree that I will be responsible for the emergency medical charges.
I understand that by entering my full name, this acts as my signature. (Type in First, Middle, Last) REQUIRED Please fill out this field. Please enter valid data.
Date REQUIRED Please fill out this field. Please enter a date.

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MOTHER / GUARDIAN INFORMATION

Full Legal Name of Mother / Guardian REQUIRED Please fill out this field. Please enter valid data.
Street Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Email Address REQUIRED Please fill out this field. Please enter valid data.
Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
Religion REQUIRED Please fill out this field. Please enter valid data.

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FATHER INFORMATION

Full Legal Name of Father REQUIRED Please fill out this field. Please enter valid data.
Address REQUIRED Same Different (Please list street, city, state in the next line) Please fill out this field.
Address IF DIFFERENT Please enter valid data.
Email Address REQUIRED Please fill out this field. Please enter valid data.
Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
Religion REQUIRED Please fill out this field. Please enter valid data.

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Emergency Contact Information

In an emergency, when unable to reach a parent or guardian, please indicate your preferred emergency contact person.

Emergency Contact #1 Please enter valid data.

E.C. #1 Phone Number Please enter valid data.

Emergency Contact #2 Please enter valid data.

E.C. #2 Phone Number Please enter valid data.

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PERMISSIONS AND DISCLAIMERS

Included in this section are Participation Release Form, Diocese of Lansing - Media Release Form, Communication Release Form. The full language or a hard copy can be accessed HERE.

When you click YES on each of the buttons below, you are agreeing and authorizing St. Thomas Aquinas.

Your YES will act as your personal signature and dating of the document.

My Child has permission to participate in activities Yes No

The Diocese of Lansing has permission to use the image of my child. Yes No

The staff of St. Thomas Aquinas or St. John Church may be communicating with members of our family. Yes No

Religious Education Registration

Disclosure Statement A

Disclosure Statement B

PERMISSION FOR DISCLOSURE AND EMERGENCY MEDICAL TREATMENT

Emergency Contact Information

PERMISSIONS AND DISCLAIMERS