WEST FORK CATHOLIC COMMUNITY

St. Michael Church; 208 Brandon Street, PO Box 99; Kingsley, Iowa 51028-0099; 712-378-2021
2014-2015 FAITH FORMATION REGISTRATION

First Name: Last Name:

Birthday: Gender: Grade:
Parish Status: N

Parent/Guardian Name(s):
Street Address:
Mailing Address:
Home Phone:
Parents Cell Phone(s):
Parents Work Phone(s):
Email Address:
Sacraments Received Yes/No Date Church
Baptism
Reconciliation
First Eucharist
Confirmation
Health/Emergency Contact Information [this information will be held confidential]
Diet Restrictions/Allergies:
Medications/Learning Disabilities:
Medical Conditions/Limitations:
Emergency Contact Name (Non-Parent):
Relationship:
Phone Number:
I hereby consent to the participation of my child in the parish Faith Formation program held at St. Michael Catholic
Church-Kingsley • 208 Brandon Street • PO Box 99 • Kingsley, IA 51028-0099

I understand this program will take place on parish property under the supervision of parish staff and volunteers.
(Additional permission will be needed for any activities, which will take place off parish property [i.e. field trips].)

MEDICAL MATTERS: I hereby warrant that to the best of my knowledge, my child is in good health, have noted specific
issues above, and I assume all responsibility for the health of my child. If my child requires medication during class time,
I will notify the Director of Faith Formation.

EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I hereby give permission to transport my child to a
hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital
or doctor. In the event of an emergency, we will use the emergency contact on this form.

Parent/Guardian _______________________________________________ Date ___________________

I do not want my child included in any photographs. _______________________________________

Parent Signature

Non-Catechists FEE: Catechist FEE: FOR OFFICE USE ONLY

1 child = $25 FREE Total Amount Due:

2 children = $50 FREE Total Amount Paid: Cash Check #

3 or more $75 FREE
Balance Due:
(Maximum Fee Per Family) (Maximum Fee Per Family)

Please complete both sides of form

 Parent Gift Program

So the children may experience the best possible program, every parent’s involvement is necessary. Initial to
indicate where each parent is willing to volunteer*. We will contact you when needed.

Support during class time: Help with projects:

___Baby sit for training classes for catechists ___Class projects
___ Substitute teach grades____ ___Nativity Pageant
___Substitute as an aide for grades____ ___Chaperone youth events
___Teach one class for those becoming Catholic (RCIA/RCIC) ___ Making phone calls
___Aide in distributing treats for Faith Formation classes ___Creative help (signs, signing, ideas)
___Saints Parade
___ Living Stations
Teams (committees): ___Provide food for an event
___RE/YM Committee ___Give a witness talk
___Youth Ministry Core Team
Times I am typically available:
___after school
*contact with youth on a regular basis [weekly] will require ___evenings
compliance with the Safe Environment Program. ___ weekends

Pick up Permission for Child in PS-4:

Children in grades PS-4 must be picked up in the hall unless you give permission for them to walk home. Please
choose one of the following:
___My child has permission to walk home.

___My child will be picked up by _______________________________________________________

(Name of person(s) picking up youth and relationship)
First Catechist Agreement

As parents, you are the primary teachers of your child. The parish Faith Formation Program is available to assist you
with the task of teaching your child about our Catholic faith. However, the parish program cannot and should not
take the place of parents in passing on the faith. All parents are expected to help their child learn the prayers and
lessons appropriate to their grade level. Parents are responsible for bringing their child to Mass each weekend and
Holy Day and participating in the sacraments. Parents are expected to assist in the classrooms of their child when
asked to do so.

I have read the above statement and understand my role as the first teacher of the Catholic faith and I take
responsibility to assist in my child’s faith formation.

__________________________________________________________ ____/_____/_____
Signature of the Parent/Legal Guardian Date

THANK YOU
 PARENTAL/GUARDIAN CONSENT FORM
AND LIABILTY WAIVER
MISSION/FIELD TRIP

Participant’s name:

Birth date:

Parent/Guardian’s name:

Home Address:

Home Phone: Business Phone:

I, _________________________________________________________ grant permission for my child,

(child’s name) to participate in this parish/school sponsored event that
requires transportation to a location away from the parish site. This activity will take place under the guidance and
direction of parish/school employees and/or volunteers from St. Michael Church - Kingsley (name of
parish/school)

A brief description of the activity follows:

Date of event: 2014-2015 Faith Formation Year
Type of event: Visiting Nursing Home
Destination of event: Kingsley Nursing Home
Individual in charge: Marie Washburn
Estimated time of departure and return: 4:00-5:00 p.m. or 7:00-8:00 p.m.
Mode of transportation to and from event: Walking

As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named
minor (“participant”).

I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless
and defend (name of parish/school) St. Michael Church - Kingsley, its officers, directors, employees and
agents, and The Diocese of Sioux City, its employees, and agents and chaperones, or representative
associated with the event for reasonable attorney’s fees and expenses which may incur in any action
brought against them as a result of such injury or damage, unless such claim arises from negligence of the
parish/school/diocese.

Student Signature: Date:

Guardian Signature: Date: