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RELIGIOUS EDUCATION REGISTRATION

FAITH FORMATION &/OR CONFIRMATION

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NOTE:

In accordance with the Diocese of Bridgeport guidelines for Religious Education:

** ALL CHILDREN WHO ARE TO RECEIVE THE SACRAMENT OF PENANCE AND THE SACRAMENT OF FIRST EUCHARIST MUST HAVE BEEN IN A RELIGIOUS EDUCATION PROGRAM FOR 1 YEAR BEFORE THE START OF THESE SACRAMENTS. **

** ALL CHILDREN WHO ARE TO RECEIVE THE SACRAMENT OF CONFIRMATION MUST HAVE BEEN IN A RELIGIOUS EDUCATION PROGRAM AT LEAST 2 YEARS BEFORE THE START OF THIS SACRAMENT.

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Public/Private School Students Fee: Kindergarten – 8th Grade:

(1 Child $25.00) (2 Children $45.00) (Family $60.00)

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Child First Name:

Child Middle Name:

Child Last Name:

Is your child Special Needs?

Address 1:

City:

State:

Zip

Birth Date

Age :

Gender

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** We need a copy of Baptism Certificate and Birth Certificate on file in the office **

Baptism Date

Place of Baptism - NAME

Place of Baptism Country

Place of Baptism ADDRESS # & STREET

Place of Baptism - CITY

Place of Baptism - STATE

Place of Baptism - ZIP

Sacraments Child has Received ... ... ... ... ... ... ... ... (check all that apply)

Number of years in a Religious Education Program, years & where attended

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The student is currently experiencing or has recently had problems with:

Child Allergies

Are immunizations current?

Date of last Tetanus Shot (mm/dd/yyyy)

Has your child been exposed to any communicable disease in the past 6 months? (If yes, please specify)

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PARENT/GUARDIAN INFO

PARENT/GUARDIAN INFO

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** Please make sure your cell phone and email are correct, most info will be sent through email or text message **

Mother Name:

Mother Marital Status

Mother Maiden Name

Mother Address

Mother Cell Phone

Mother Home Phone:

Mother Work Phone:

Mother E-mail:

Mother: Are you a registered parishioner?

Mother: I am the legal guardian of the child listed above.

Father Name:

Father Marital Status

Father Address:

Father Cell Phone:

Father Home Phone:

Father Work Phone:

Father E-mail :

Father: Are you a registered parishioner?

Father: I am the legal guardian of the child listed above.

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Emergency Contact:

Emergency Contact Relation to Child:

Emergency Contact Phone:

PERMISSIONS

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Parent Role

The role that parents play in the education of their children is very important. It is the right and duty of parents to be the first and primary educator of their children. Education in faith by the parents should begin in the child’s earliest years. Parents have the mission of teaching their children to pray and discover their vocation as children of God. The Parish is the Eucharistic community and the heart of the liturgical life of Christian Families.

Please Check all that apply:

As a parent or guardian, I am formally registered in the Catholic Church.

I/We participate in the in my parish, by at the least, weekly attendance of Sunday Mass and Holy days with our children

My child(ren) will be in attendance & participate in Sunday Mass, not just Religious Education classes & retreats.

As a part of my ministry as a Catholic parent, I would like to volunteer service. Please let me know of opportunities.

The Catholic Church and Parish that you are registered to:

PERMISSION and RELEASE ** (Please read and check off the boxes to accept the release statements below)

Publicity Release: I understand that from time to time the church may use photographs/video recordings of participants for public relations interest stories, articles, news and other marketing of Blessed Sacrament Church in the newspaper, on television, and the web site. I give permission for such photographs of my child to be used for marketing purposes. I give The Church of the Blessed Sacrament permission to audio, video, and photograph for the purposes of public relations and promotions without compensation or approval rights (i.e. brochure mailings, highlight promotional videos, and photos for our website).

Medical Release: The health history is correct so far as I know, and the person described has permission to engage in all activities except as noted. In Case of Medical Emergency, if I cannot be contacted, I hereby give permission to a Blessed Sacrament Church representative and the physician he/she selects to secure proper treatment, including: hospitalization, ordering injections, giving anesthesia, x-rays, routine tests, treatment, transporting of child, or performing operations as may be urgently necessary for this child and to release reports necessary for insurance purposes for my child noted above. I authorize Blessed Sacrament Church to obtain medical treatment for my child in an emergency or to take other necessary actions for my child’s safety and well-being. I release and agree to indemnify Blessed Sacrament Church from any liability to any person arising out of good faith decisions made by Blessed Sacrament Church pursuant to the provisions of this paragraph. This form may be copied for emergency purposes. I understand that every effort will be made to contact the participants responsible parent or guardian. I further understand that if I do not have medical insurance that covers all costs, I will be responsible for such medical costs.

Transportation Release: I hereby give permission for my child, to participate in the transportation program and to travel on a school bus for field trips with the Blessed Sacrament Church. I also give my permission for my child to be transported, if necessary, in emergency situations, as well as, when Blessed Sacrament Church needs to be evacuated for the safety of the children.

Liability Release: In consideration of being permitted to participate in any way in the activities at and to attend The Church of the Blessed Sacrament Programs, I, for myself, my child, my heirs, personal representatives or assigns, do hereby release waive, discharge, and covenant not to sue The Church of the Blessed Sacrament, its parent organization, its officers, employees, and agents, from liability from any and all claims including the negligence of The Church of the Blessed Sacrament, its parent organization, its officers, employees, and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to the activities and attendance at The Church of the Blessed Sacrament Programs. I warrant that my child is physically fit and able to participate in all activities except those listed above. I also agree to INDEMNIFY AND HOLD HARMLESS the Church of the Blessed Sacrament, its parent organization, its officers, employees, and agents, from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney's fees, as a result of my child's attendance and involvement in any activities at The Church of the Blessed Sacrament Programs. Including any claim asserted by my child after he/she become an adult. I also acknowledge that I have read the above and understand that I am giving up substantial rights, including the right to sue. I acknowledge that I am signing freely and voluntarily, and intend by my signature to a complete and unconditional release of all liability to the greatest extent allowed by law.

PARENT SIGNATURE:

About Us

We welcome you all to be part of our community.

QUICK LINKS

CONTACT

203-333-1202

pastor@blessedsacramentbpt.org

275 Union Ave, Bridgeport, CT, United States

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