Our Lady of Perpetual Help Church | Reg. Teen RCIA 2023-2024

Student Name *

First

Middle

Last

Parent's Email - Main Contact *

Address *

Address Line 1

City

State

Zip Code

Date of Birth *

Age *

Gender *

School Grade (as of aug. 2023) *

School Attending *

Is Child Baptized *

Teen RCIA *

Year 1 (click here if this is your teen’s first year attending) - $ 120.00
Year 2 (click here if your teen attended last year) - $ 245.00

Teen RCIA classes are for grades 9-12

Medical Conditions *

Allergies *

Special Needs *

Name of Parish if student attended last year

PARENT INFORMATION

Father's Name *

Father's Cell Phone *

Father's Religion *

Mother's Name *

Mother's Cell Phone *

Mother's Religion *

EMERGENCY CONTACT INFORMATION

List 2 Persons Other Than Parents

Emergency Contact #1 *

Other Than Parents

City (E1) *

Cell Phone (E1) *

Relationship to Child (E1) *

Emergency Contact #2 *

Other Than Parents

City (E2) *

Cell Phone (E2) *

Relationship to Child (E2) *

Medical Release *

Emergency Acknowledgement

I hereby give permission and consent to have my child(ren) released, in my absence, to any of the two adults listed above in case of an emergency, earthquake or disaster (subject to proper identification). I have notified these two adults of this consent and permission. I hereby permit my son/daughter to participate in all activities pertaining to the Religious Education Program 2022-2023 at Our Lady of Perpetual Help Parish. I hereby release OLPH School/ Parish from any and all liability arising there from. I hereby consent to have my child(ren) receive first aid and/or emergency treatment as determined by paramedic or appropriate school personnel, as the need arises.

Image & Info Release *

Image/visual likeness:
Name:

The Archdiocese/School/Parish intends to use your child’s image and name, for the following non-commercial purposes (describe class/ activity, date(s) if applicable): Photos taken during all RELIGIOUS EDUCATION EVENTS..... https://olphdowney.com/wp-content/uploads/2022/06/2022-2023-Parents-Authorization-to-Use-Childs-Image.pdf

Birth Certificate *

Please upload Birth Certificate

Baptismal Cert. *

Please upload Baptismal certificate

Total

$ 0.00