High School Confirmation Registration Form

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Program Information

"Year 1" HIGH SCHOOL CONFIRMATION (9th to 12th Grade)

Continuing "Year 2" HIGH SCHOOL CONFIRMATION (9TH to 12th Grade)

Program Selection

Select Program of interest: REQUIRED Year 1 Confirmation Program Continuing Year 2 Program. MUST have already completed one year of Confirmation preparation at St. Lawrence to select Year 2. Please fill out this field.

Registration Fees

Year 1 Confirmation Program Fee- $175; (The total program cost for both years is $350.)

If you prefer to make the payment in increments, a minimum deposit of $40 toward the Confirmation program fees must be submitted on or before the Year 1 Confirmation Orientation (Sunday, September 15th, 2024 4:30PM English/Spanish in the Community Center) to secure your candidate's registration.

Year 2 Confirmaton Program Fee- $175 in addition to any unpaid balances from the previous 2023-2024 year. (The total program cost for both years is $350.)

HOW TO PAY

Payments can be made online or with cash/check at the Parish Office M-F 10AM-5PM. You may also drop off payments after hours in the front office door mailslot in an envelope marked "HIGH SCHOOL CONFIRMATION PAYMENT FOR < >." Checks should be made payable to St. lawrence and should indicate "Confirmation - Candidate's name" in the memo line.

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.

Birthdate REQUIRED Please fill out this field. Please enter a date.

Age REQUIRED Please fill out this field. Please enter valid data.

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.

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

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

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

T-Shirt Size REQUIRED Please fill out this field.

Student's Email Address (Please DO NOT type parent's email address in this section) Please enter an email address.

Student Information - Sacrament of Baptism

Confirmation Candidates MUST provide a copy of their Baptismal Certificate. Certificate must be translated into English if originally in another language.

Is your child baptized? REQUIRED Yes, my child is baptized. No, my child is NOT baptized. Please fill out this field.

Date of Baptism Please enter a date.

Name and Address of church/parish where your child was baptized at. Please enter valid data.

Student Information - Sacrament of Holy Communion

Has your child had First Communion? REQUIRED Yes, my child has already received First Communion. No, my child has Not yet received First Communion. Please fill out this field.

Date of First Communion Please enter a date.

Name and Address of Church/Parish where your child received First Communion Please enter valid data.

Mass and Attendance Policy

MASS ATTENDANCE:

Weekly Mass Attendance is a requirement for all Confirmation Candidates.

St. Lawrence Weekend Mass schedule: Saturdays 5PM (Vigil Mass), Sundays 8:00AM, 10:00AM, 12:30PM (SPANISH). Beginning September 15th, 2023, there will also be an additional Sunday Mass at 6PM (Bilingual English/Spanish) generally on the 1st and 3rd Sundays of each month which all Year 1 and Year 2 Candidates and their families are expected to attend together. Please be sure to sign the Mass attendance binder marked "High School Confirmation Mass Participation" located at the back table of the church.

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 Sunday Masses in either the home parish or at Saint Lawrence.

I have read the Mass Attendance policy and I understand that my candidate must attend Mass EVERY week and join the 6:00PM Mass on 1st and 3rd Sundays of the month. REQUIRED Yes No Please fill out this field.

ATTENDANCE POLICY:

All candidates are expected to attend all sessions, group service projects/trainings, and retreats. Candidates are allowed 2 EXCUSED absences only. A missed retreat will need to be made up at another parish.

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

RETREAT PERMISSION

Each year of Confirmation preparation, candidates attend a retreat to deepend their faith.

Year 1 Candidate Retreat (For Year 1 Candidates only in 9th-11th Grade):

Location: St. Lawrence the Martyr
Date: TBD
Time: TBD
Cost: Included in the registration fees.

Year 2 Candidate Weekend Retreat (For Year 2 Candidates and / or all High School Seniors/12th Graders):

Weekend Overnight Retreat
Location: TBD
Date: TBD (Anticipated for February 2025)
Time: TBD
Cost: Included in registration fees. Covers food, lodging, charter bus transportation from St. Lawrence, and retreat materials.

I give permission for my child permission to attend the retreat. (All High School Seniors must attend Year 2 Weekend retreat.) REQUIRED Yes No. I understand that my child must attend an alternative Confirmation retreat at another parish. Please fill out this field.

Parish Information

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

If responded "Yes" to the question above type envelope # 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 reach you.

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

Secondary Phone # of Parent to call 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 a phone number.

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

Name of Emergency Contact #2 (Other than Parent) Please enter a phone number.

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

Health Information

List allergies, special needs, and / or other medical information (e.g., physical restrictions, mental health conditions, developmental conditions): Please enter valid data.

Medicine my child is currently taking: Please enter valid data.

Authorization for Emergency Medical Treatment

Authorization is hereby given to St. Lawrence representative 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.

Doctor's Name: REQUIRED Please fill out this field. Please enter valid data.

Doctor's Phone number Please enter valid data.

Dentist Name: REQUIRED Please fill out this field. Please enter valid data.

Phone number of Dentist Please enter valid data.

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

Medical Plan/Policy Holder's Name Please enter valid data.

Policy Number/Medical Plan Number Please enter valid data.

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 becomes 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 permission to the physician selected by the St. Lawrence activities supervisory personnel then present to render medical treatment deemed necessary and appropriate by the physician.

Indicate Permission and Acknowledgement Yes, I give permission. No, I do not give permission and I understand my child cannot participate in the program.

Photography 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 parish@saintlawrence.org. 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. We share these memories with each other in various ways including DVD / CD, Social Media (e.g., Facebook, Instagram, Friends Only) and internet communication (e.g., email). 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 publish any photographs or videos in which I and/or pictures or videos of my parents, siblings, grandparent(s) and/or family appear while participating in any program with St. Lawrence the Martyr ministry. There will be no compensation for use of any photographs at the time of publication or in the future.

Indicate Consent Yes, I give consent. No, I do not give consent.

Walking or Biking Home Authorization

My student has my permission to WALK or BIKE HOME from St. Lawrence, weather permitting.

Indicate Permission REQUIRED Yes, I give permission for my child to walk or bike home. No, I do not give permission. I will let my child know he or she cannot walk/bike home. Please fill out this field.

Parental Permission and Acknowledgement of Conditions for Participation in 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 not limited to transportation to and from activities.
2. I/we agree to direct 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 Yes, I give permission. No, I do not give permission and I understand my child cannot participate in the program.

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 Yes, I give permission. No, I do not give permission and I understand my child cannot participate in the program.

ELECTRONIC SIGNATURE

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