Confirmation Program Registration

CANDIDATE INFORMATION

Sacrament Preparation REQUIRED Year 1 Year 2 Please fill out this field.

Other Sacraments Needed Baptism First Holy Communion

Candidate's First and Last Name REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Birth Date REQUIRED Please fill out this field. Please enter valid data.

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

Birth Place REQUIRED Please fill out this field. Please enter valid data.

School Attending REQUIRED Please fill out this field. Please enter valid data.

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

Living Arrangements REQUIRED Both Parents Mother Only Mother/Stepfather Father Only Father/Stepmother Grandparent(s) Guardian(s) Please fill out this field.

Are there any custody issues or a restraining order in place? REQUIRED Yes No Please fill out this field.

If yes, submit a copy of the most recent applicable court order(s) to the Office.

Given the nature of the program, does your child have any physical, mental, emotional, cognitive, or other limitations or restrictions that would require the parish to make a minor adjustment to enable your child to participate? REQUIRED Yes No Please fill out this field.

If yes, what type of restriction does your child have or what adjustment(s) will be needed? Please enter valid data.

List any medical condition which restricts physical activity or requires special attention or minor adjustments. Include conditions such as asthma or allergies (e.g. peanuts, bee stings, etc.). If none, please indicate “none”. REQUIRED Please fill out this field. Please enter valid data.

Does your child take any medication(s)? REQUIRED Yes No Please fill out this field.

If yes, please provide a list Please enter valid data.

PARENT / GUARDIAN INFORMATION

Mother/Stepmother Information

Full Name Please enter valid data.

Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Cell Phone Please enter valid data.

Work Phone Please enter valid data.

Email Please enter valid data.

Religion Please enter valid data.

Father/Stepfather Information

Full Name Please enter valid data.

Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Cell Phone Please enter valid data.

Work Phone Please enter valid data.

Email Please enter valid data.

Religion Please enter valid data.

By checking the box, I give permission for my child to participate in this Confirmation Program, whether conducted onsite or online.

I Agree Please select this field.

EMERGENCY CONTACT INFORMATION
(If a parent or guardian can't be reached in an emergency)

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

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

Address Please enter valid data.

Cell Phone REQUIRED Please fill out this field. Please enter valid data.

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

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

Address Please enter valid data.

Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Is your family registered at St. Thomas Aquinas Church? REQUIRED Yes No Please fill out this field.

If yes, include Parish Envelope # Please enter valid data.

EMERGENCY/EARTHQUAKE PARENTAL CONSENT

List all allergies or allergic reactions to any food, medication, insect bites, existing illness, previous serious illnesses, and injuries. Please enter valid data.

I hereby attest that I am entitled to legal custody and possession of my child, and accordingly am authorized to respond to this emergency form.

I Agree Please select this field.

In the event that I cannot be reached to make arrangements for emergency medical care at the time of illness or accident, I hereby authorize St. Thomas Aquinas Catholic Church and/or its Representative(s) to take my child to the doctor or hospital.

I Agree Please select this field.

Doctor Information REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter valid data.

Hospital Information REQUIRED Please fill out this field. Please enter valid data.

Member ID Number Please enter valid data.

I give permission to the adults working with St. Thomas Aquinas Catholic Church Confirmation Program to give medical care as needed, including permission to the physician selected to render any medical or surgical care deemed necessary to my child if a parent and/or guardian cannot be reached. I understand that in the event that professional medical care is needed, I will be notified as soon as possible at one of the numbers listed under the Contact Information provided.

I Agree Please select this field.

It is understood that by selecting 'I Agree' on this consent form, the parent/guardian absolves St. Thomas Aquinas Catholic Church and its Religious Education Confirmation Program, the Staff, and any and all members of its governing Boards from any responsibility for the safety, welfare, health, and well-being of the student, beyond such matters as may be called reasonable care for the student in custody of an adult working with the St. Thomas Aquinas Catholic Church and subject to the adults' clear instructions. Should it be necessary for the student to receive medical attention or to return home due to medical reasons, disciplinary action, or otherwise, I hereby assume all medical and transportation costs.

I Agree Please select this field.

PUBLICATION OF PHOTOGRAPHY CONSENT

I understand that from time-to-time St. Thomas Aquinas Catholic Church may wish to publish photographs of Religious Education and/or Confirmation candidates in the Sunday Bulletin or in another church related publication. The Sunday Bulletin is posted on the St. Thomas Aquinas website on an Internet accessible World Wide Web server. I understand that St. Thomas Aquinas’ website may also wish to use photographs of Religious Education and/or Confirmation candidates. Photographs posted on the internet may include only the last name initial and first name of the Religious Education and/or Confirmation candidates.

I acknowledge that the church website content is not private and can be reviewed, copied, downloaded, and transmitted by anyone with access to the internet and that St. Thomas Aquinas Catholic Church has no control over this. I hereby waive, release, and forever discharge any and all claims, demands or causes of actions against St. Thomas Aquinas Catholic Church and its facility, staff, employees, agents, contractors, and any other person, organization or entity assisting them in connection with the posting of information on the website for damages or injuries in any way related to, connected to, or arising from the publishing or posting of information on the church’s internet website or the use of that information and expressly assume the risk of any injury or damage resulting from said posting of information on the website.

I further understand and agree that this authorization will remain in effect until such time as it is withdrawn in writing.

I understand that if I change my mind relating to this authorization, that I will submit another authorization form to St. Thomas Aquinas Catholic Church,

My son(s)/daughter(s) photograph(s) may be published in the Sunday Bulletin or in another church-related publication and posted on the St. Thomas Aquinas Catholic Church website on the internet. REQUIRED Yes No Please fill out this field.

CONFIRMATION SACRAMENTAL PREPARATION COMMITMENT STATEMENT FOR PARENTS

Our Confirmation Program plays a crucial role in fostering the spiritual growth of the Candidate. With classes meeting only twice a month, consistent attendance is vital. Your commitment as parents is essential to ensuring that the Candidate learns, understands, and appreciates the significance of their Catholic faith. Setting a positive example, such as bringing the Candidate to Confirmation preparation classes punctually and attending Mass together every Sunday, reinforces the importance of faith in the Candidate's life.

Check all that apply REQUIRED I agree and understand that during preparation for Sacraments, the Candidate's attendance is vital I agree and understand that we will attend Mass on a regular basis I agree and understand that I will attend the mandatory Sacramental preparation meetings Please fill out this field.

REFERRED BY: Please enter valid data.