Register Your Child in Catechesis of the Good Shepherd

Child's Full Name REQUIRED Please fill out this field. Please enter valid data.

Home Address REQUIRED

Please include both street address and if applicable, PO Box number

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.

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

Gender REQUIRED Male Female Please fill out this field.

Was Child Baptized? REQUIRED Yes No Please fill out this field.

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

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

Complete the contact information for the
CHILD'S MOTHER below:

Type mother's first name and maiden name below:

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

Mother's maiden name REQUIRED Please fill out this field. Please enter valid data.

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

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

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

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

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

Home 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.

Complete the contact information for the
CHILD'S FATHER below:

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

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

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

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

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

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

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

Home 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.

Home Phone Number Please enter a phone number.

Child resides with REQUIRED Both parents Mother Father Legal guardian Please fill out this field.

Is there any additional information we should know about your child? Are there any special health considerations? REQUIRED

Please enter "NONE" if there are no concerns we need to be aware of.

Please fill out this field.

Please list the names of two individuals who will regularly pick up your child and provide phone contact 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.

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

Relationship to child. REQUIRED Please fill out this field. Please enter valid data.

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

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

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

Relationship to child REQUIRED Please fill out this field. Please enter valid data.

Consistent routines are extremely important for young children. If in an emergency, neither of these individuals are available to pick up the child, parents must provide advanced written notice of the person picking up the child, the relationship to the child and a phone contact.

Emergency Contact Information

Person to contact if parents cannot be reached. REQUIRED

Please give contact information specific to the time of the Religious Education session.)

Please fill out this field. Please enter valid data.

Relationship to child REQUIRED Please fill out this field. Please enter valid data.

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

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

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

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

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.

Emergencies in the Atrium are highly unlikely, but some situations like bee stings or falls are always possible. It is good practice to have a plan in place so everyone understands what will happen in the event of unexpected emergency.

Procedure to be followed in an emergency.

I understand that in case of an emergency, "911" will be called and an ambulance may be called by the Catechist or her designate.

In case of accident or illness, I request that the catechist or assistant of the CSG program contact me. If I am unable to be reached, I hereby authorize this representative to make whatever arrangements are necessary for the proper treatment of my child. I agree to assume the financial responsibility for any diagnosis, treatment and/or medication deemed necessary.

To the best of my knowledge all information given is accurate and complete. I hereby consent to, and authorize the necessary procedures that have been stated above.

I Agree Please select this field.

Agreement to be used in case of

a child with allergies

Does child have allergies? REQUIRED Yes No Please fill out this field.

Please list allergies REQUIRED

Please list all of the child's known allergies. If the child has no allergies, please enter "N/A."

Please fill out this field.

Course of action to be followed if allergy presents an emergency condition: REQUIRED

Please provide all follow up to an allergic emergency. If the child has no allergies, please enter "N/A."

Please fill out this field.

Please complete this section only if your child has allergies. Parentd and CGS Catechist agree on the following course of action:

What allergy medication will be administered?

List all medications to be administered. If the child does not require medication, please enter "NONE."

Who will administer allergy medication? Please enter valid data.

Role of this person. Please enter valid data.

Where will this allergy medication be kept so as to be readily available? Please enter valid data.

What other actions will be taken?

By whom? Please enter valid data.

Whenever emergency medication is
administered, "911" will be called without exception.

I Agree Please select this field.

Although this year it is unlikely that parents will be called on to help, in the future parents will be asked to commit to 10 hours of service to the program each year. Please check the best ways for us to use your gifts & talents. REQUIRED Catechist Assistant in atrium Substitute assistant in the atrium Preparation of materials Assist with special events Copying & collating material Other ways you think you might be able to help. Please fill out this field.

Other suggestions for ways you might be able to help: Please enter valid data.

St. John the Evangelist/St. Charles Borromeo Parish

Register Your Child in Catechesis of the Good Shepherd

Catechesis of the Good Shepherd Registration

Complete the contact information for the
CHILD'S MOTHER below:

Complete the contact information for the
CHILD'S FATHER below:

Registration fees accompanying
this form are most appreciated.

Register Your Child in Catechesis of the Good Shepherd

Complete the contact information for the CHILD'S MOTHER below:

Complete the contact information for the CHILD'S FATHER below:

Registration fees accompanying this form are most appreciated.

Complete the contact information for the
CHILD'S MOTHER below:

Complete the contact information for the
CHILD'S FATHER below:

Registration fees accompanying
this form are most appreciated.