Religious Education

How Many Children Do You Wish To Register? REQUIRED Please fill out this field.
Child 1
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Birth Date REQUIRED Please fill out this field. Please enter a date.
- Child's Grade Level in Fall REQUIRED Please fill out this field.
- What School Does Your Child Attend? REQUIRED Please fill out this field. Please enter valid data.
- Has your child been baptized? REQUIRED Yes No Please fill out this field.
- Information and Restrictions (i.e., medical or health conditions, allergies, special needs, etc.)
- Your child may be included in photographs and/or videos taken while at St. Monica Parish.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your child's photo/video/name to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Monica Parish permission to edit, use, and reuse photos/videos/name for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Monica Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Monica Parish to use your child's photo or video clips of your child for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
- Permission to use child's picture/video? REQUIRED YES NO Please fill out this field.
Child 2
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Birth Date REQUIRED Please fill out this field. Please enter a date.
- Child's Grade Level in Fall REQUIRED Please fill out this field.
- What School Does Your Child Attend? REQUIRED Please fill out this field. Please enter valid data.
- Has your child been baptized? REQUIRED Yes No Please fill out this field.
- Information and Restrictions (i.e., medical or health conditions, allergies, special needs, etc.)
- Your child may be included in photographs and/or videos taken while at St. Monica Parish.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your child's photo/video/name to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Monica Parish permission to edit, use, and reuse photos/videos/name for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Monica Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Monica Parish to use your child's photo or video clips of your child for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
- Permission to use child's picture/video? REQUIRED YES NO Please fill out this field.
Child 3
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Birth Date REQUIRED Please fill out this field. Please enter a date.
- Child's Grade Level in Fall REQUIRED Please fill out this field.
- What School Does Your Child Attend? REQUIRED Please fill out this field. Please enter valid data.
- Has your child been baptized? REQUIRED Yes No Please fill out this field.
- Information and Restrictions (i.e., medical or health conditions, allergies, special needs, etc.)
- Your child may be included in photographs and/or videos taken while at St. Monica Parish.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your child's photo/video/name to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Monica Parish permission to edit, use, and reuse photos/videos/name for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Monica Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Monica Parish to use your child's photo or video clips of your child for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
- Permission to use child's picture/video? REQUIRED YES NO Please fill out this field.
Child 4
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Birth Date REQUIRED Please fill out this field. Please enter a date.
- Child's Grade Level in Fall REQUIRED Please fill out this field.
- What School Does Your Child Attend? REQUIRED Please fill out this field. Please enter valid data.
- Has your child been baptized? REQUIRED Yes No Please fill out this field.
- Information and Restrictions (i.e., medical or health conditions, allergies, special needs, etc.)
- Your child may be included in photographs and/or videos taken while at St. Monica Parish.
  
  Please indicate, by checking the box below, whether or not you grant your permission for your child's photo/video/name to be used in print, on the internet, and/or in other forms of media.
  
  If you check "YES", you agree to give St. Monica Parish permission to edit, use, and reuse photos/videos/name for non-profit purposes including use in print, on the internet, and all other forms of media. You also release St. Monica Parish, the Diocese of Kalamazoo, and its agents, volunteers, and employees from all claims, demands, and liabilities whatsoever in connection with the above use.
  
  If you check "NO", you are indicating that you do NOT want St. Monica Parish to use your child's photo or video clips of your child for any other purposes, including use in our bulletin, use on our website, and use on our social media pages.
- Permission to use child's picture/video? REQUIRED YES NO Please fill out this field.

Family Information

Parent's Full Names (First, Maiden, Last) REQUIRED Please fill out this field. Please enter valid data.
Primary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Secondary Guardian Name Please enter valid data.
Secondary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Family 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.
Primary Email Address REQUIRED Please fill out this field. Please enter an email address.

Heath Insurance REQUIRED Please fill out this field. Please enter valid data.

Insurance Policy and Group/Contract Information REQUIRED Please fill out this field.

If not registered in our parish, in which parish is your family currently registered? Please enter valid data.

In consideration of my child being allowed to participate in faith formation and youth ministry on campus events, I agree to indemnify and hold harmless St. Monica Catholic Parish, and any and all affiliated organizations, their employees, agents, representatives, including volunteer and other drivers, from any and all claims, negligence, arising from or relating to my child’s participation. This indemnification does not apply to claims for intentional misconduct or gross negligence.
By entering into and/or signing this document, the signatory/signatories agree to conduct its/their dealings via electronic means. The signatory agrees that allowing dealings via electronic means will facilitate these dealings. The signatory has the option to opt to sign things in a paper format.

I Agree Please select this field.

Parent/Legal Guardian Electronic Signature REQUIRED Please fill out this field.

Add'l notes

Saint Monica Catholic Church

Kalamazoo, mi

Religious Education

Registration Form Grades 1-8

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