Family Evangelization and Catechesis Registration Family & Youth Evangelization & Catechesis Registration Form 2022-2023 Step 1 of 5 20% Family InformationPlease 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 PhoneIs your family registered as a member of Our Lady of Mercy parish?* Yes No Information - Parent / GuardianMother's / Guardians's Name* First Last Mother's / Guardian's Cell Phone*Information - Parent / Guardian 2Father's / Guardian's Name* First Last Father's / Guardian's Cell Phone* Information and PoliciesPlease fill out the information below. You may leave the Confidential information blank if there are no concerns.Confidential InformationTo 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 PERMISSIONSGeneral 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 BEHAVIORINFRACTION 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 FORMMedical 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 InformationOur 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 NumberVIDEOS, PHOTOS, and VIRTUAL PLATFORMSVIDEOS, 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 CONTACTContact 1 - Name First Last Contact 1 - Cell PhoneContact 1 - Relationship Contact 2 - Name First Last Contact 2 - Cell PhoneContact 2 - Relationship *** GUIDE TO REGISTRATION SELECTIONS ***Please review the following descriptions before selecting the Family Faith Formation options below for your child(ren).Families New to Faith Formation (a.k.a. RE) --- Students in Kindergarten - Grade 5If this is your child(ren)'s first year in Family Faith Formation, select SEEK and ROOT. This allows families to experience our story of faith and know our core beliefs. Below, for both SEEK and ROOT, choose one of the two date/time options for each of these faith journeys.Familes with Students in Grade 2 - Grade 5 Who Completed at Least One Year of Faith Formation and Need SacramentsIf your child(ren) grade 2 - grade 5, have already received a full year of faith formation and need to prepare for the Sacraments of Reconciliation or Holy Communion, please select MEND and NOURISH this year, (anticipating SEEK and ROOT next year), or if your family schedule allows, you may select SEEK, ROOT, MEND & NOURISH. Down below, choose one of the two date/time options for each of the faith journeys you select. Families with Students in Grade 3 - Grade 5 Continuing to Grow in FaithFamilies come to grow deeper in faith as Catholic Christians knowing the kerygma- our story of faith, and studying the core beliefs we profess in the Creed. Please select one of the two options below for both SEEK and ROOT. Students in Grade 6 - Age 17 Needing Sacraments of Baptism, Reconciliation / Holy CommunionIf you have a youth entering grade 6 - age 17, and they need to prepare for the Sacraments of Reconciliation or Holy Communion, then select MEND and NOURISH. Below, choose one of the date and time options for each of these programs. *Note: Middle School students enrolling in MEND & NOURISH faith journeys should also enroll in EDGE (middle school faith formation) and if in grades 9 or 10 LIGHT (high school faith formation which includes Teen ALPHA). The registration for EDGE and LIGHT are located separately.Students in Grade 6 - 8 (EDGE Program)The EDGE is a Catholic middle school youth ministry experience created for early adolescents in grades six, seven and eight. The EDGE is designed to meet the educational, spiritual, emotional, and social needs of young adolescents. Kids are always welcomed and encouraged to invite their friends to the EDGE. Students in grades 6, 7 and 8 will participate in the EDGE program starting in September and going until April. Topics will be presented to educate about the Christian Catholic faith and challenge the student to grow in a relationship with Christ. There will be large and small group activities.Students in Grade 9 - 12 (LIGHT & Sacrament of Confirmation Program)The L.I.G.H.T. (Living in God’s Holy Truth) program is designed to nourish and strengthen faith formation during all four years of high school. The courses and activities within the program are geared toward strengthening the high school teens’ relationship with Jesus, increasing their desire to serve and affirming their understanding of the Catholic Church. The L.I.G.H.T. program encompasses four “Basic” faith themes: Profession of Faith, Sacraments of Faith, Life of Faith, and Prayer in the Life of Faith. Through thought-provoking mini-courses, faith sharing small groups, youth group activities, retreats, social activities, and service and discipleship projects, the teens will understand that faith is a journey for life and that the sacrament of Confirmation becomes part of the journey — not the end of the journey.Student Information and RegistrationPlease list all students you will be registering for Faith Formation programs (Age Kindergarten-Grades 12). Information and details on specific programs will be sent to you after registration.Student Name #1* First Last Student Birth Date* MM slash DD slash YYYY School Attending in Fall 2022 GRADE entering school in the Fall 2022*K123456789101112Sacraments the Student has Received Baptism Reconciliation Communion/Eucharist Confirmation Please check all sacraments that have already been received.Was child Baptized at Our Lady of Mercy parish? Yes No Register for all appropriate programs based on the desciptions above. SEEK, Option 2 - WEDNESDAY, 6:15-7:30 - DATES: 9/28, 10/5, 10/19, & 10/26 ROOT, Option 2 - WEDNESDAY, 6:15-7:30 - DATES: 11/16, 12/14, 1/11. 2/8, 3/22, 4/19 ROOT, Option 2 - WEDNESDAY, 6:15-7:30 - DATES: 11/16, 12/14, 1/11. 2/8, 3/22, 4/19 MEND, Option 1 - Saturday, 5:15-6:30 (This time follows the 4 P.M. Saturday Mass) - DATES: 11/5, 12/3, 1/21 MEND, Option 2 - Sunday, 8:30-9:45 (This time leads to the 10 A.M. Sunday Mass) - DATES: 11/6, 12/4, 1/22 NOURISH, Option 1 - Saturday, 5:15-6:30 (This time follows the 4 P.M. Saturday Mass) - DATES: 3/18, 4/15, 4/29 NOURISH, Option 2 - Sunday, 8:30-9:45 (This time leads to the 10 A.M. Sunday Mass) - DATES: 3/12, 4/16, 4/30 EDGE - Monday, 6:30-8:30pm - DATES: 9/19, 10/3, 10/17, 11/7, 11/21, 12/5, 12/19, 1/9, 1/23, 2/6, 2/20, 3/6, 3/20, 4/17 LIGHT Student Name #2 First Last Student Birth Date MM slash DD slash YYYY School Attending in Fall 2022 GRADE entering school in the Fall 2022K123456789101112Sacraments the Student has Received Baptism Reconciliation Communion/Eucharist Confirmation Please check all sacraments that have already been received.Child was baptized at Our Lady of Mercy parish? Yes No Register for all appropriate programs based on the desciptions above. SEEK, Option 2 - WEDNESDAY, 6:15-7:30 - DATES: 9/28, 10/5, 10/19, & 10/26 ROOT, Option 1 - SUNDAY, 11:15 – 12:30 - DATES: 11/13, 12/11, 1/8, 2/5, 3/19, 4/23 ROOT, Option 2 - WEDNESDAY, 6:15-7:30 - DATES: 11/16, 12/14, 1/11. 2/8, 3/22, 4/19 MEND, Option 1 - Saturday, 5:15-6:30 (This time follows the 4 P.M. Saturday Mass) - DATES: 11/5, 12/3, 1/21 MEND, Option 2 - Sunday, 8:30-9:45 (This time leads to the 10 A.M. Sunday Mass) - DATES: 11/6, 12/4, 1/22 NOURISH, Option 1 - Saturday, 5:15-6:30 (This time follows the 4 P.M. Saturday Mass) - DATES: 3/18, 4/15, 4/29 NOURISH, Option 2 - Sunday, 8:30-9:45 (This time leads to the 10 A.M. Sunday Mass) - DATES: 3/12, 4/16, 4/30 EDGE - Monday, 6:30-8:30pm - DATES: 9/19, 10/3, 10/17, 11/7, 11/21, 12/5, 12/19, 1/9, 1/23, 2/6, 2/20, 3/6, 3/20, 4/17 LIGHT Student Name #3 First Last Student Birth Date MM slash DD slash YYYY School Attending in Fall 2022 Grade entering school in the Fall 2022K123456789101112Sacraments the Student has Received Baptism Reconciliation Communion/Eucharist Confirmation Please check all sacraments that have already been received.Child was baptized at Our Lady of Mercy parish? Yes No Register for all appropriate programs based on the desciptions above. SEEK, Option 2 - WEDNESDAY, 6:15-7:30 - DATES: 9/28, 10/5, 10/19, & 10/26 ROOT, Option 1 - SUNDAY, 11:15 – 12:30 - DATES: 11/13, 12/11, 1/8, 2/5, 3/19, 4/23 ROOT, Option 2 - WEDNESDAY, 6:15-7:30 - DATES: 11/16, 12/14, 1/11. 2/8, 3/22, 4/19 MEND, Option 1 - Saturday, 5:15-6:30 (This time follows the 4 P.M. Saturday Mass) - DATES: 11/5, 12/3, 1/21 MEND, Option 2 - Sunday, 8:30-9:45 (This time leads to the 10 A.M. Sunday Mass) - DATES: 11/6, 12/4, 1/22 NOURISH, Option 1 - Saturday, 5:15-6:30 (This time follows the 4 P.M. Saturday Mass) - DATES: 3/18, 4/15, 4/29 NOURISH, Option 2 - Sunday, 8:30-9:45 (This time leads to the 10 A.M. Sunday Mass) - DATES: 3/12, 4/16, 4/30 EDGE - Monday, 6:30-8:30pm - DATES: 9/19, 10/3, 10/17, 11/7, 11/21, 12/5, 12/19, 1/9, 1/23, 2/6, 2/20, 3/6, 3/20, 4/17 LIGHT Student Name #4 First Last Student Birth Date MM slash DD slash YYYY School Attending in Fall 2022 GRADE entering school in the Fall 2022K123456789101112Sacraments the Student has Received Baptism Reconciliation Communion/Eucharist Confirmation Please check all sacraments that have already been received.Child was baptized at Our Lady of Mercy parish? Yes No Register for all appropriate programs based on the desciptions above. SEEK, Option 2 - WEDNESDAY, 6:15-7:30 - DATES: 9/28, 10/5, 10/19, & 10/26 ROOT, Option 1 - SUNDAY, 11:15 – 12:30 - DATES: 11/13, 12/11, 1/8, 2/5, 3/19, 4/23 ROOT, Option 2 - WEDNESDAY, 6:15-7:30 - DATES: 11/16, 12/14, 1/11. 2/8, 3/22, 4/19 MEND, Option 1 - Saturday, 5:15-6:30 (This time follows the 4 P.M. Saturday Mass) - DATES: 11/5, 12/3, 1/21 MEND, Option 2 - Sunday, 8:30-9:45 (This time leads to the 10 A.M. Sunday Mass) - DATES: 11/6, 12/4, 1/22 NOURISH, Option 1 - Saturday, 5:15-6:30 (This time follows the 4 P.M. Saturday Mass) - DATES: 3/18, 4/15, 4/29 NOURISH, Option 2 - Sunday, 8:30-9:45 (This time leads to the 10 A.M. Sunday Mass) - DATES: 3/12, 4/16, 4/30 EDGE - Monday, 6:30-8:30pm - DATES: 9/19, 10/3, 10/17, 11/7, 11/21, 12/5, 12/19, 1/9, 1/23, 2/6, 2/20, 3/6, 3/20, 4/17 LIGHT ADDITIONAL INVITATIONS TO FAMILY FAITH FORMATION, KINDERGARTEN - GRADE 5Family ALPHA Parents and their children are invited to encounter the Lord anew through Family Alpha! Held on Thursdays, once a week, for 11 consecutive weeks, from 6:30-8:30pm, September-November and January-March. The session includes dinner for both the parents and the children. Parents will be grouped with fellow parents whose children are in the same grade. Parents with several children will have the option to choose the parent grade level grouping they wish. The prayer and vision of Family Alpha are two-fold; to provide a place of encounter so as to equip, our parents, and grow them in their confidence to be the primary influence of your child(ren)'s faith. To further accompany our parents so that they don't feel alone in being the influencers of the Catholic faith to your children, parents and children will be invited to an after Alpha further accompaniment into Households of Faith Grow Groups after the Alpha season. Contact Zara Tan for more information or proceed to olmercy.com/familyalpha Choose the Family ALPHA option below: Family ALPHA Volunteers Needed!We need many people to help with the various programs we offer. Please check the box below if you would like to help OR if you would like more information and we'll contact you.Yes, I'd like to volunteer to help with Family Faith Formation Grades K- 5 in the following areas: Volunteer as a ROOT/SEEK Table Leader (Adults) Volunteer as a ROOT/SEEK Catechist (K-5) Volunteer as a ROOT/SEEK Teen/Tween (Grades 6 - 12) Catechist Assistant Volunteer to help with Family Events such as Family Faith Formation Kick-Off Picnic, Trunk or Treat with the Saints, or An Evening in Bethlehem Volunteer to help in the Formation Office Yes, I'd like to volunteer to help with EDGE Middle School Ministry in the following areas: Volunteer as an Adult EDGE Catechist (for 10 students) Volunteer as a Teen EDGE Co-Catechist (for 10 students) Volunteer as an EDGE Adult Building Volunteer (when we meet in the PLC) Volunteer to help with EDGE Retreats Volunteer to help with EDGE Social and/or Social events Yes, I'd like to volunteer to help with LIGHT High School Ministry, including the Sacrament of Confirmation, in the following areas: Volunteer as an Adult Host or Helper for Alpha Youth Series Volunteer as a Teen Host or Helper for Alpha Youth Series Volunteer as an Adult Mini-Course Facilitator (teach a 4 week course) Volunteer as an Adult Confirmation Prep Facilitator (teach a 5 week course) Volunteer as an Adult Faith Mentor for teens Volunteer to Help with Retreats Volunteer to Help with Social events Volunteer to Help with Service projects Volunteer as a Parent volunteer for summer Mission Trip Your Name First Last Email Cell Phone TuitionOur 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 331-707-5369After 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!PhoneThis field is for validation purposes and should be left unchanged.