St. Angela Merici Catholic Church Junior High Ministry (714) 529-1821 Ext. 147 2012-2013 Junior High Registration Welcome! The Junior High Ministry program is open to any family registered in our parish. Families not registered in the parish will be required to pay an out of parish fee. If this is your child s FIRST year of faith formation and entering 7 th or 8 th grade please complete a Children s Faith Formation registration packet. If you have a child needing baptism please contact the Parish Office at: (714) 529-1821. Registration closes on Friday, September 14, 2012. There is a fee of $35.00 per family. This fee is waived if all tuition and fees are paid at the time of registration. Please complete and return the following forms: Family Registration Form New Student Information Form This information is needed for first enrollment of a child or children. Returning Students Please complete bottom half of New Student Form. Emergency Contact Form Fee Schedule with Tuition Agreement Checks should be made payable to St. Angela Merici. Media Form A form must be signed for each child enrolled in the program. Extra forms are available online or in the Parish Center Office.
Today s date St. Angela Merici Junior High Ministry Family Registration Form (714) 529-1821 Ext. 147 Family Name: Street Address: City: Zip Code: Home Phone: Registered at this Church: Y N If yes, Envelope Number: *If you are not registered or Out of Parish you will be charged a $50.00 fee* Parent/Guardians Relationship to child/ren: Name: Mr. Mrs. Ms. Miss Dr. Circle one Business Phone: Cell Phone: Email: Religion: Marital Status: Relationship to child/ren: Name: Mr. Mrs. Ms. Miss Dr. Circle one Business Phone: Cell Phone: Email: Religion: Marital Status:
St. Angela Merici Catholic Church Junior High Ministry (714) 529-1821 Ext. 147 Junior High Classes Monday 6:30pm 8:00pm 7 th grade & 8 th grade These students have very busy schedules and we would like to minister to their catechetical and spiritual needs in a comfortable and welcoming environment. Class is held twice monthly with the hope students can feel committed to both school and discerning their faith journey. *If this is your child s first year of faith formation (religious education), please contact the Children s Faith Formation coordinator at 714-529-2311 BEFORE completing any paper work.* Classes begin Monday October 8, 2012
New Student Information (JH) Student Name: Sex: Grade for the 2012-2013 school year: Birth date: Date Place Baptism was performed Baptism: / / Reconciliation: yes no 1 st Eucharist (Communion) yes no Confirmation yes no Previous Religious Classes #years Parish Registering for grade: 7 th or 8 th (please circle) Comments, health problems, other conditions: Student Name: Sex: Grade for the 2012-2013 school year: Birth date: Date Place Baptism was performed Baptism: / / Reconciliation: yes no 1 st Eucharist (Communion) yes no Confirmation yes no Previous Religious Classes #years Parish Registering for grade: 7 th or 8th (please circle) Comments, health problems, other conditions: Returning Students (JH) 1) grade 7 th or 8 th (please circle) 2) grade 7 th or 8 th (please circle) 3) grade 7 th or 8 th (please circle) 4) grade 7 th or 8 th (please circle) 5/12
St. Angela Merici Catholic Church Junior High Ministry 2012-2013 Parent/Guardian Permissions for Media Activities At St. Angela Merici Church and Junior High Ministry we take the issue of child safety very seriously, and this includes the use of images of students. Including images of students in Faith Formation publications, church bulletins and website can be motivating for the students involved, and provide a good opportunity to promote the work of St. Angela Merici Church and Junior High Ministry. However, the Church and Faith Formation have a duty of care towards students, which means that students must remain unidentifiable, reducing the risk of inappropriate contact, if images are used in this way. Parents must consent to the Church and Faith Formation taking and using photographs and images of their children. We will never include the full name of the pupil alongside an image. Please complete below, sign and return this form with your completed registration. I consent to photographs and digital images of the child named below, appearing in St. Angela Merici Church and Junior High Ministry printed publications or on the church website. I understand that the images will be used only for educational purposes and that the identity of my child will be protected. I also acknowledge that the images may also be used and distributed by other media, such as CD-ROM, as part of the promotional activities of the Church or Junior High Ministry. I hereby grant permission for my child to participate in media activities while enrolled in Junior High Ministry. (A form must be signed for EACH child registered in the Junior High Ministry program. Additional forms are available through the Parish Center Office.) I do NOT wish my child to participate for this school year. Name of child: Grade: Name of parent/guardian: Signature: Date:
Family Registration Fee St. Angela Merici Junior High Ministry Fee Schedule Worksheet 2012-2013 This fee is waived if all tuition and fees are paid at the time of registration. $35.00 Tuition 1 child $95.00 2 or more children $160.00 Out of Parish or Not Registered in Parish (This fee must be paid at time of registration.) Total $50.00 Balance No child will be denied faith formation due to an inability to pay. Families with financial concerns are asked to call the office to make other arrangements. Tuition Agreement Please check one: I am paying all fees now. I will pay balance in 3 payments. (Statements will be mailed.) I will call the office to make other arrangements. Signature Date For Office Use Only Total Due $ Amt. Pd. $ Ck# Cash Date Initials Remainder $ Amt. Pd. $ Ck# Cash Date Initials Remainder $ Amt. Pd. $ Ck# Cash Date Initials 05/12
EMERGENCY CONTACT & MEDICAL TREATMENT FORM This form will only be used when parent cannot be located Father s Name Mother s Name Address Phone Participant Name Grade Participant Name Grade Participant Name Grade Participant Name Grade Do hereby authorize ST. ANGELA MERICI JUNIOR HIGH MINISTRY, as agent for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the Medical Practice Act on the medical staff of ST. JUDE HOSPITAL whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but it is given to provide authority and power on the part of our aforesaid agent to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain in effect until REVOKED. In case o f emergency, please list PRECAUTIONS to be taken for any of the above students. SIGNED: DATE: 05/12 (Parent or Legal Guardian) In the event of an Earthquake or serious disaster, please list names of persons OTHER THAN THE PARENT that your child/children can be released to: Name Relationship to Child Telephone Cell Phone Name Relationship to Child Telephone Cell Phone ALLERGIES/MEDICAL PROBLEMS/DISABILITIES (PLEASE LIST FOR EACH CHILD) Name Conditions Name Conditions