Faith Formation Registration Form (CCD)

 ST. TIMOTHY FAITH FORMATION                                 Office use only
                                                                                             2016-2017                                                                                                                       Date:____________

                                                                                    NEW REGISTRATION                                                                                                            Paid:_____________

                                                                                                                                                                                                                                                                                                  Check #:__________

 

All classes are held on Sundays.  Grades K-5 meet from 10:30 AM-11:45 AM Attendance at the 9:30 AM Mass constitutes part of the teaching. – Grades 6-10 meet 6:15-7:45 PM in accordance with a set schedule.  Attendance at the 5:15 PM Mass constitutes part of the teaching.  Attendance at all Masses is monitored.  You must be registered at St. Timothy Church for your child/children to participate in the Faith Formation program.

 

FAMILY NAME:___________________________________________________________________________________________________

 

STUDENT NAME(S):_______________________________________________________________________________________________

 

ADDRESS:________________________________________________________________________________________________________

 

HOME PHONE:__________________________CELL (MOM):_________________________CELL (DAD):_________________________

 

E-MAIL ADDRESS:________________________________________________________________________________________________

 

OUR PRIMARY COMMUNICATION WITH YOU IS VIA E-MAIL.  CHECK HERE:_____IF YOU DO NOT HAVE AN E-MAIL ADDRESS

 

IN CASE OF AN EMERGENCY WHERE WE ARE NOT ABLE TO CONTACT YOU, PLEASE INDICATE THE PERSON(S) TO BE CONTACTED:

 

NAME:__________________________________________________________PHONE:____________________CELL:________________
 

MEDICAL OR /BEHAVIORAL CONDITIONS:____________________________________________________________________________________________________

 

FATHER OR MALE GUARDIAN                                                                   MOTHER OR FEMALE GUARDIAN

RELATIONSHIP TO CHILD:___________________________           RELATIONSHIIP TO CHILD:______________________________
 

NAME:___________________________________________________NAME:_________________________________________________

 

OCCUPATION:____________________________________________OCCUPATION:_________________________________________

 

BUSINESS PHONE:_________________________________________BUSINESS PHONE:______________________________________

 

RELIGION:________________________________________________RELIGION:_____________________________________________

 

MARITAL STATUS:________________________________________MARITAL STATUS:______________________________________

 

 MAIDEN NAME:________________________________________

The registration fee for the upcoming school year will be:

$60.00 for 1 child and $90.00 for 2 or more

 

All checks should be made payable to St. Timothy Church.  Please do not put payments in the collection basket.
 

A COPY OF THE CHILD’S BAPTISM CERTIFICATE MUST BE PROVIDED FOR OFFICE RECORDS,(if baptized in a church other than St. Timothy), BEFORE ANY OTHER SACRAMENT CAN BE RECEIVED.  Please contact the Church where your child was Baptized and have them fax us a copy of his/her Baptism Certificate.  Our Fax number is 738-2466.

 

            If your child/children has/have had religious instruction elsewhere, please indicate their name(s) and the name of the parish.

STUDENT NAME(S):___________________________________________________________________________

CHURCH NAME:__________________________________________GRADE(S):___________________________

 

STUDENT 1   Faith Formation entering grade:________   Is this child in a different grade in school?  If so, what grade:_____

STUDENT NAME:____________________________________ MIDDLE NAME: ___________________________________

DATE OF BIRTH____/____/____GENDER :_______________SCHOOL:__________________________________________

Student resides with:   (__both parents)   (___mother)   (___father)   (___other NAME:  _______________________________)

Are there any special circumstances regarding child custody or persons to whom your child may not be released?

If so, please explain.______________________________________________________________________________________

RELIGION:_____________________________ Has this student been baptized in the Roman Catholic Church?___YES___NO

Address of the Church where the student was baptized: __________________________________________________________

_______________________________________________________________________________________________________

Has this student been baptized in another Christian denomination?     ___YES – Please list:__________________________

Has this student made his/her First Penance?                                       ___YES           ___NO

Has this student made his/her First Communion?                                            ___YES           ___NO

HEALTH PROBLEMS: __________________________________ Does your child have any allergies?      _____YES_____NO

Food(s):________________________________________________Other allergies:____________________________________

Does your child carry an Epi-Pen or have medication of any type with them?_________________________________________

Does your child have any special learning needs and if so, does he/she require any special accommodations?

If yes, please explain.______________________________________________________________________________________

 
 

STUDENT 2   Faith Formation entering grade:________   Is this child in a different grade in school?  If so, what grade:_____

STUDENT NAME:____________________________________ MIDDLE NAME: ___________________________________

DATE OF BIRTH____/____/____GENDER :_______________SCHOOL:__________________________________________

Student resides with:   (__both parents)   (___mother)   (___father)   (___other NAME:  _______________________________)

Are there any special circumstances regarding child custody or persons to whom your child may not be released?

If so, please explain.______________________________________________________________________________________

RELIGION:_____________________________ Has this student been baptized in the Roman Catholic Church?___YES___NO

Address of the Church where the student was baptized: __________________________________________________________

_______________________________________________________________________________________________________

Has this student been baptized in another Christian denomination?     ___YES – Please list:__________________________

Has this student made his/her First Penance?                                       ___YES           ___NO

Has this student made his/her First Communion?                                            ___YES           ___NO

HEALTH PROBLEMS: __________________________________ Does your child have any allergies?      _____YES_____NO

Food(s):________________________________________________Other allergies:____________________________________

Does your child carry an Epi-Pen or have medication of any type with them?_________________________________________

Does your child have any special learning needs and if so, does he/she require any special accommodations?

If yes, please explain.______________________________________________________________________________________

 
 

In the event of any emergency, I hereby give permission to transport my child/children to a hospital for emergency medical or surgical treatment.  I wish to be advised prior to any further treatment by the hospital or doctor.

Family Doctor:__________________________________________________________Phone:__________________
 

Volunteer positions include:  Teacher, Aide, Sub, Hall Monitor, and Office Assistant

I wish to volunteer for: ___________________________________________________________________________________________

 

Even if you cannot volunteer for any of the positions above, do you have some particular talent you are willing to share, such as music, arts & crafts, sewing/altering costumes, drama experience, baking, etc.?       ___Yes                  ___No

Please list: ________________________________________________________________________________________________________
 

When I had my child/children baptized, I accepted responsibility as primary religious educator and example in matters of the faith.  I know that the Church is here to support me in educating my child in our Catholic faith.

 

PARENT SIGNATURE:___________________________________________________DATE:_________________

 

 

The United States Conference of Catholic Bishops has adopted the "Charter For The Protection Of Children And Young People" which requires that all dioceses in our Nation implement "Safe Environment Programs". In response to this mandate, all those working with youth receive appropriate training to provide a safe environment for children and young people in our Diocese. The Charter also requires that students in our schools and parish religious education programs receive information pertaining to their personal safety. All school-age children in our Diocese will receive this information in Catholic school religion classes or in parish religious education classes. A "Safe Environment" curriculum has been developed for use in this Diocese known as "The Circle of Grace". Teachers have been provided with lesson plans and age-appropriate material focusing on personal safety for our youth. This includes information about appropriate/inappropriate forms of touching; maintaining safe relationships, both personal and on the internet, and identifying trusted adults to confide in. If for some reason you do not want your child to participate in these classes, you must submit a signed written request stating that you refuse to allow your child to participate in this training. Training for all grades usually begins in November, at the teacher's discretion. If you have any questions, please do not hesitate to call Lucille Peloquin at 738-9079 or e-mail at sttimothysre@aol.com.

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Faith Formation parents should have received re-enrollment forms via e-mail. Please call the Faith Formation office with any questions or to enroll  at 738-9079.