Family Evangelization and Catechesis Registration

Family & Youth Evangelization & Catechesis Registration Form 2022-2023

Step 1 of 5

Family Information
Please complete this registration form for ALL your children (Grades K-12) who will be in a program this coming year. Please fill out the family information below.
Family Last Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email - Primary where all correspondences will be sent.*
Cell Phone - Primary where all correspondence will be sent.*
Home Phone
Is your family registered as a member of Our Lady of Mercy parish?*
- Yes
- No
Information - Parent / Guardian
Mother's / Guardians's Name*
First Last
Mother's / Guardian's Cell Phone*
Information - Parent / Guardian 2
Father's / Guardian's Name*
First Last
Father's / Guardian's Cell Phone*

Information and Policies
Please fill out the information below. You may leave the Confidential information blank if there are no concerns.
Confidential Information
To best support you and your child(ren), please let us know of any allergies, physical limitations, learning challenges, special needs and/or family circumstances (recent separation, divorce, death or illness). Please contact Mary Jo (331-707-5378) or Dave Miserendino (331-707-5371) prior to the start of classes so we may learn how to support you in the care of your child(ren)’s needs and faith development. Thank you!
GENERAL PERMISSIONS
General Permissions Consent*
I agree to the General Permissions Consent.
I request that my child(ren) be allowed to participate in Family & Youth Evangelization & Catechesis programs. I hereby release and indemnify my parish, its staff, volunteers, and the Diocese of Joliet from any and all liability arising from claims of any kind or nature whatsoever from my child's participation.
I agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless and defend Parish, Our Lady of Mercy Catholic Church, and the Diocese of Joliet, its officers, directors, agents, employees, or representatives from any and all liability for illness or death arising from or in connection with my participation.
CODE OF BEHAVIOR
INFRACTION OF THESE RULES CAN MEAN IMMEDIATE DISMISSAL WITH NO REFUND.
Code of Behavior Consent*
Yes, I consent to the Code of Behavior.
I acknowledge that I am representing our diocese/parish during this event, and I will represent us well. I will adhere to all Diocesan
Guidelines and display responsible, mature, and respectful behavior in my words, actions, and usages.

Expectations
1. All participants are expected to arrive on time.
2. All participants are expected to demonstrate respect and common courtesy at all times. Inappropriate language/behavior/conduct will not be tolerated.
3. Socializing should always be done in public areas.
4. Dress should reflect the values of modesty and respect, and inscriptions and images on clothing should reflect Christian values.
5. The possession or consumption of any alcoholic beverages is prohibited.
6. The possession of any illegal substances is prohibited and subject to legal action.
7. Smoking, vaping, e-cigarettes, smokeless tobacco, and cannabis in any form are prohibited.
8. Weapons and/or drug paraphernalia are prohibited.

I understand and agree to the Code of Behavior. I also understand and agree that at the time of an infraction requiring dismissal, l will be notified and/or I will be responsible for any and all costs related to the participants dismissal from activities and any all costs assessed by local authorities.
MEDICAL PERMISSION FORM
Medical Permission Consent*
Yes, I consent to the Medical Permission Consent.
I grant permission for the administration of First Aid to my child/children by the people in charge of the event and those transporting my child to and from the event as their judgement deems advisable and to make the necessary referrals to qualified physicians for the treatment of illness or accidents of a more serious nature. I understand I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay of such communication would endanger life. In the case of a medical emergency, I understand that every effort will be made to contatct the parent/guardian of the participant. In the event that I cannot be reached I hereby give permission to the physicians selected by the adult staff to hospitalize, secure proper treatment for and to order injections, anesthesia or surgery if deemed necessary for my child.
Medical Insurance Information
Our Diocese ask for the information below to assure for child safety when they are in the care of the parish program.
Medical Insurance/Policy in the name of:
Medical Insurance Company
Policy/Identification Number
Authorized Physician
Physician Phone Number
VIDEOS, PHOTOS, and VIRTUAL PLATFORMS
VIDEOS, PHOTOS, AND VIRTUAL PLATFORMS CONSENT
I agree to the video and photograph policy.
Videos and/or photos may be taken during this event. This authorization consent constitutes permission to use my child(ren)'s image in video and/or photos which may be used for future promotional efforts including the parish and /or Diocese of Joliet website.
EMERGENCY CONTACT
Contact 1 - Name
First Last
Contact 1 - Cell Phone
Contact 1 - Relationship
Contact 2 - Name
First Last
Contact 2 - Cell Phone
Contact 2 - Relationship

Tuition
Our tuition will now include all students in grades K-12 in the tuition/fee plan below. Please indicate how many total students you have in the programs (K-5, EDGE and LIGHT). ***There is also an additional Sacrament Fee for those students (ages 7 - 17) preparing to receive their Sacraments (Baptism, First Reconciliation, First Eucharist) and for those students preparing to receive the Sacrament of Confirmation.
Tuition Fees (Grades K - 12)*
- Families with 1 child/student ($175)
- Families with 2 children/students ($275)
- Families with 3 or more children/students ($350)
Sacrament Fees - 1st Reconciliation/1st Communion (Ages 7 - 17) and Confirmation
- Child/Student preparing for a sacraments. ($100)
A fee of $100 is charged for every child/student, preparing to receive the sacrament of 1st Reconciliation / 1st Communion or Confirmation.
If you have more than one student in your family receiving a Sacrament, contact please contact Karen Schwartz in the Family Faith Formation Office at karens@olmercy.com or 331-707-5369
After you hit SUBMIT, you will be redirected to the PAYMENT page to make payment by credit/debit card. You may indicate a FULL payment or 1/2 payment option. If tuition is a financial hardship, there is an additional option to select for Tuition Assistance. Or if you would like to submit a check or cash as payment, or have any questions, please contact Karen Schwartz in the Family Faith Formation Office at karens@olmercy.com or 331-707-5369. THANK YOU!
Please Sign Name Electronically Below*
First Last
The parties agree that this document may be electronically signed and that the electronic signatures appearing on this document are the same as handwritten signatures for the purposes of validity, enforceability and admissibility. Transmission via email is not encrypted, so if you are concerned about the security of your sensitive information, please print and fax this form, surface mail it or hand deliver it.
Please click submit when you are finished filling out the form. Thank you!
Name
This field is for validation purposes and should be left unchanged.

Family Evangelization and Catechesis Registration

Family Evangelization and Catechesis Registration

Family & Youth Evangelization & Catechesis Registration Form 2022-2023

Step 1 of 5

Family Information

Information - Parent / Guardian

Information - Parent / Guardian 2

Information and Policies

GENERAL PERMISSIONS

CODE OF BEHAVIOR

MEDICAL PERMISSION FORM

Medical Insurance Information

VIDEOS, PHOTOS, and VIRTUAL PLATFORMS

EMERGENCY CONTACT

* GUIDE TO REGISTRATION SELECTIONS *

Families New to Faith Formation (a.k.a. RE) --- Students in Kindergarten - Grade 5

Familes with Students in Grade 2 - Grade 5 Who Completed at Least One Year of Faith Formation and Need Sacraments

Families with Students in Grade 3 - Grade 5 Continuing to Grow in Faith

Students in Grade 6 - Age 17 Needing Sacraments of Baptism, Reconciliation / Holy Communion

Students in Grade 6 - 8 (EDGE Program)

Students in Grade 9 - 12 (LIGHT & Sacrament of Confirmation Program)

Student Information and Registration

Volunteers Needed!

Tuition

Please click submit when you are finished filling out the form. Thank you!

Family & Youth Evangelization & Catechesis Registration Form 2022-2023

Step 1 of 5

Family Information

Information - Parent / Guardian

Information - Parent / Guardian 2

Information and Policies

GENERAL PERMISSIONS

CODE OF BEHAVIOR

MEDICAL PERMISSION FORM

Medical Insurance Information

VIDEOS, PHOTOS, and VIRTUAL PLATFORMS

EMERGENCY CONTACT

*** GUIDE TO REGISTRATION SELECTIONS ***

Families New to Faith Formation (a.k.a. RE) --- Students in Kindergarten - Grade 5

Familes with Students in Grade 2 - Grade 5 Who Completed at Least One Year of Faith Formation and Need Sacraments

Families with Students in Grade 3 - Grade 5 Continuing to Grow in Faith

Students in Grade 6 - Age 17 Needing Sacraments of Baptism, Reconciliation / Holy Communion

Students in Grade 6 - 8 (EDGE Program)

Students in Grade 9 - 12 (LIGHT & Sacrament of Confirmation Program)

Student Information and Registration

Volunteers Needed!

Tuition

Please click submit when you are finished filling out the form. Thank you!

* GUIDE TO REGISTRATION SELECTIONS *