PreK-8th Grade Catechetical Registration Form

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PROGRAM INFORMATION

PROGRAM SELECTION

Select Program you are registering for SUNDAY SCHOOL (PreK,Kinder, 3rd-5th Grade) THIS IS NOT A FIRST COMMUNION PROGRAM. Sundays, 11:15AM-12:15PM. Begins September 15th, 2024. FIRST COMMUNION PREPARATION (1st to 8th Grade) Two Year Program. Sundays, 11:15AM-12:15PM. Begins Sunday, September 15th, 2024. BAPTISM FOR OLDER CHILDREN (Children 7 years old to 8th grade who are NOT YET BAPTIZED) After completing this form, please schedule an interview with Eleanor de Paz (408) 296-3000 or email [email protected]. Middle School Youth Ministry (6th-8th Graders) THIS IS NOT A FIRST COMMUNION PROGRAM. Begins September 8th, 2024

REGISTRATION FEES

SUNDAY SCHOOL (Pre-K to 6th Grade)

One Child $70; Two Children $135; Three or more children $190.

FIRST COMMUNION PREPARATION (1st to 8th Grade)

Year 1 Program Fee: One Child $70; Two children $135; Three or more children $190.
Year 2 Program Fee: One Child $70; Two children $135; Three or more children $190.
($140 Total for both years)

BAPTISM PREPARATION FOR OLDER CHILDREN (7 years old to 8th Grade who are NOT YET BAPTIZED).

Must contact Eleanor de Paz for a family interview (408) 296-3000 Ext. 433 or email [email protected] to request an appointment. The process for Christian Initiation will be discussed at the interview.

Middle School Youth Ministry (6th to 8th Grade)

$30 per student

Payments
Payments for program fees can be made online (link provided once registration form is submitted) or at the Parish Office M-F 10am-5pm. You may also drop off the program fee payments after hours at the mailslot at the Parish Office door if it is placed in an envelope marked "First Communion or Sunday School Payment for < >"

STUDENT INFORMATION

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Age REQUIRED Please fill out this field. Please enter an integer (number).

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.

Grade in the 2024-2025 School Year REQUIRED Please fill out this field.

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

Check all Sacraments that your child HAS ALREADY received. REQUIRED Baptism. (My child is baptized) First Communion/First Eucharist. (My child has received the Sacrament of Holy Communion/Eucharist) Confirmation. (My child has received the Sacrament of Confirmation) None - I am not Catholic None - I want more information about Sacraments Please fill out this field.

Student Information - Sacrament of Baptism

First Communion students MUST provide a copy of their Baptismal Certificate no later than the first day of class. Certificates can be dropped of at the Parish Office M-F, 10AM to 5M or a clear photo or scan can be e-mailed to [email protected]. Certificate must be translated into English if originally in another language.

Is your child baptized? REQUIRED Please fill out this field.

Date of Baptism Please enter a date.

Name and Address of the CHURCH where the baptism took place. Please enter valid data.

Student Information - Sacrament of Communion

Has your child already received First Communion? REQUIRED Please fill out this field.

Date of First Communion Please enter a date.

Name and Address of Church and address where First Communion was received Please enter valid data.

MASS AND ATTENDANCE POLICY

MASS ATTENDANCE: Weekly Mass attendance is a requirement for all students, most especially students preparing for First Communion. Mass times as St. Lawrence are Saturdays 5PM (Vigil Mass), Sundays 8:00AM, 10:00AM, 12:30PM (Spanish). There will also be an additional Sunday Mass at 6pm (Billingual English/Spanish) two Sundays a month. PLEASE PLAN TO ATTEND MASS AT 10:00AM (ENGLISH) or 12:30PM (SPANISH) as our Sunday morning class times fall between these two Masses.

If your family is registered at another Parish, a "Pastor's Letter" Form provided by Saint Lawrence Catechetical Ministries must be signed by the pastor of your home parish and submitted to Eleanor de Paz, Catechetical Director. This letter serves to inform your home parish that your child is participating in the Sacramental Preparation program at Saint Lawrence and is expected to attend and participate in weekly Masses in either their home parish or at Saint Lawrence.

I have read the Mass Attendance policy and I understand that my child must attend Mass every week. REQUIRED Yes No Please fill out this field.

ATTENDANCE POLICY: All students are expected to attend classes every week. Students preparing in First Communion preparation are allowed 2 EXCUSED absences only.

I have read and understood the Attendance Policy REQUIRED Yes No Please fill out this field.

PARISH INFORMATION

Are you a Registered Parishioner of St. Lawrence? REQUIRED No Yes Please fill out this field.

If answered Yes - Envelope # Please enter valid data.

If registered at another catholic parish, enter the name of the Catholic Parish below. Please enter valid data.

PARENT/ GUARDIAN INFORMATION

Mother's First Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Last Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Mother's Email REQUIRED Please fill out this field. Please enter an email address.

Father's First Name REQUIRED Please fill out this field. Please enter valid data.

Father's Last Name REQUIRED Please fill out this field. Please enter valid data.

Father's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Father's Email REQUIRED Please fill out this field. Please enter an email address.

Student lives with: REQUIRED Both parents Mother only Father only Grandparent(s) Other Please fill out this field.

Language(s) spoken at home: REQUIRED Please fill out this field. Please enter valid data.

EMERGENCY CONTACTS

Please provide at least one Emergency Phone # where we can reach you, and at least one Alternate Emergency Contact and Phone # in the event we cannot each you.

Primary Phone # of Parent REQUIRED Please fill out this field. Please enter a phone number.

Secondary Phone # of Parent REQUIRED Please fill out this field. Please enter a phone number.

Name of Emergency Contact #1 (Other than parent) REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Name of Emergency Contact #2 (Other than parent) Please enter valid data.

Phone Number Please enter a phone number.

HEALTH INFORMATION

List of allergies, special needs, and / or other medical information (e.g., physical restrictions, emotional conditions) Please enter valid data.

Any medicine my child is now taking Please enter valid data.

AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

Authorization is hereby given to St. Lawrence representatives to render emergency medical treatment for any serious injury or illness to my student in the event I cannot be reached at the time of the accident or illness. I also authorize emergency transportation of my student to a hospital if deemed necessary.

Hospital I wish my child to be transported to REQUIRED Please fill out this field. Please enter valid data.

Family Physician Please enter valid data.

Family Physician's Phone Number Please enter a phone number.

Dentist Please enter valid data.

Dentist's Phone Number Please enter a phone number.

Medical Plan Name REQUIRED Please fill out this field. Please enter valid data.

Policy Number Please enter valid data.

Policy Holder's Name Please enter valid data.

Phone Number Please enter a phone number.

I am not aware of any medical condition of my student that would render it inappropriate for him/her to participate in St. Lawrence activities. In the event my student is injured or become ill and requires emergency medical attention, I understand and agree to be responsible for any such medical, dental, and/or hospital expenses incurred. I hereby give permissin to the physician selected by the St. lawrence activities supervisory personnel thne present to render medical treatment deemed necessary and appropriate by the physician.

Indicate Permission and Acknowledgement REQUIRED Yes, I give permission. No, I do not give permission and I understand my child cannot participate in the program. Please fill out this field.

PHOTOGRAPH AND VIDEO AUTHORIZATION

This consent is provided to St. Lawrence the Martyr and its representatives until such time that consent is withdrawn in writing. Consent may be withdrawn by sending email to [email protected]. A written letter may also be delivered to

St. Lawrence the Martyr
Attention: Catechetical Director
1971 Saint Lawrence Drive
Santa Clara, CA 95051

We routinely take pictures and video of St. Lawrence events and gatherings. Occasionally, we would like to be able to use these photographs and videos for flyers, parish and diocesan publications, and the ministry website. We need your consent before publishing photographs. If there are concerns about pictures or videos posted on a website, please contact your Program Coordinator / Director or webmaster, and they will promptly be removed.

I authorize and give full consent, without limitation or reservation, to St. Lawrence the Martyr, to public any photographs or vidoes in which I and/or pictures or vidoes of my parents, sibilings, grandparent(s) and/or family appear while participating in any program with St. Lawrence the Martyr ministry. There will be no compensatiopn for use of any photographs at the time of publication or in the future.

Indicate Consent REQUIRED Yes, I consent No, I do not give consent Please fill out this field.

PARENTAL PERMISSION AND ACKNOWLEDGEMENT OF CONDITIONS FOR PARTICIPATION IN THE PROGRAM

1. I/we parent or authorized guardian of the student named above give permission for his/her participation in the St. Lawrence program and all related activities, including but noit limited to transportation to and from activities.

2. I/we agree to driect my/our student to cooperate and comply with reasonable directions, rules, and instructions from St. Lawrence staff and adult volunteer leaders. In the event that my student consistently misbehaves and/or acts inappropriately; I take full responsibility for making arrangements to have my student be dismissed and sent home.

3. I/we agree to be responsible for all medical expenses relating to injury of my/our student as a result of his/her participation in these St. Lawrence activities, whether or not caused by the negligence of the parish, St. Lawrence program employees, agents or volunteers or other participants.

4. I/we understand that the youth participating in St. Lawrence activities risk injury to the body, psyche or property damage to themselves and others. Such injuries can be caused by other persons or accidentally or intentionally self-inflicted, faulty equipment or facilities, conditions of recreational facilities, vehicle accidents while in transport or through the activity itself.

Indicate permission and acknowledgement REQUIRED Yes No; I understand my child cannot participate in this program Please fill out this field.

DIOCESE OF SAN JOSE PARTICIPANT ACTIVITY WAIVER FORM

TO THE EXTENT PERMITTED BY LAW, I HOLD THE PARISH/SCHOOL AND DIOCESE OF SAN JOSE HARMLESS FROM ANY CLAIM OF INJURY, SICKNESS, ILLNESS OR DAMAGE THAT I /MY CHILD MAY SUFFER OR SUSTAIN DURING THE ACTIVITY LISTED ABOVE, WITH EXCEPTION TO INJURY OF DAMAGES ARISING OUT OF THE SOLE NEGLIGENCE OF THE PARISH/SCHOOL OR DIOCESE OF SAN JOSE. I ATTEST THAT I AM/MY CHILD IS PHYSICALLY FIT TO PARTICIPATE IN THIS EVENT.

IN THE EVENT THAT I/MY CHILD BECOME(S) ILL OR INJURED, I DO HEREBY CONSENT TO WHATEVER MEDICAL TREATMENT(S), INCLUDING BUT NOT LIMITED TO X-RAY, EXAMINATION, OR HOSPITAL CARE, CONSIDERED NECESSARY IN THE BEST JUDGEMENT OF THE ATTENDING PHYSICIAN AND PERFORMED BY OR UNDER THE SUPERVISION OF A MEMBER OF THE MEDICAL STAFF OF THE HOSPITAL AND/OR OTHER MEDICAL FACILITY PROVIDING THE TREATMENT. I AM NOT AWARE OF ANY MEDICAL CONDITION WHICH WOULD RENDER IT INAPPROPRIATE FOR
ME/MY CHILD TO PARTICIPATE IN ANY ACTIVITY ASSOCIATED WITH THIS EVENT.

Also, I acknowledge the inherent risks of exposure to COVID-19, or other infectious virus or disease and voluntarily assume the risk that I/my child may be exposed to or infected by COVID-19, or other infectious virus or disease, by participating in this activity.
I/my child understand that the PARISH/SCHOOL AND DIOCESE OF SAN JOSE have put in place rules and precautions to mitigate the spread of COVID-19. While acknowledging that these rules and precautions may or may not be effective in mitigating the spread of COVID-19, I/my child agree to comply with such rules and precautions which may include, but are not limited to, wearing a face covering, hand washing, and hand sanitizing.

I agree that if I am/my child is exhibiting symptoms of illness such as cough, shortness of breath or difficulty of breathing, fever, chills, muscle pain, headache, or sore throat, I/my child will seek medical attention as needed, and refrain from attending the mentioned activity until I get/my child gets better. I/my child hereby release and agree to hold PARISH/SCHOOL AND DIOCESE OF SAN JOSE harmless from, and waive on behalf of myself/my child, my heirs, and any personal representatives, any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself/my child and/or property that may be caused by any act, or failure to act of the PARISH/SCHOOL AND DIOCESE OF SAN JOSE, or that may otherwise arise in any way in connection with any participation of activities WITH EXCEPTION TO INJURY OR DAMAGES ARISING OUT OF THE SOLE NEGLIGENCE OF THE PARISH/SCHOOL OR DIOCESE OF SAN JOSE. I/my child understand that this release discharges the PARISH/SCHOOL AND DIOCESE OF SAN JOSE from any liability or claim that I/my child, my heirs, or any personal representatives may have against the parish with respect to any bodily injury, illness, death, medical treatment, or property damage that may
arise from, or in connection to, any participation in activities WITH EXCEPTION TO INJURY OR DAMAGES ARISING OUT OF THE SOLE NEGLIGENCE OF THE PARISH/SCHOOL OR DIOCESE OF SAN JOSE.

This liability waiver and release extends to the PARISH/SCHOOL AND DIOCESE OF SAN JOSE together with its clergy, staff, volunteers, and other participants.

Indicate waiver and release of liability REQUIRED Yes No; I understand my child cannot participate in this program Please fill out this field.

ELECTRONIC SIGNATURE

Typing Parent/Guardian name below constitutes electronic signature REQUIRED Please fill out this field.