Our Lady of Perpetual Help Church | Reg-Pre K

Family’s Last Name: *

Address *

Address Line 1

City

State

Zip Code

Email *

Phone *

Primary Language Spoken at Home: *

STUDENT # 1

Program (S1) *

Year 1 - The Sacrament of 1st Communion (gr. 1-8)
Year 2 - The Sacrament of 1st Communion (gr. 2-12)
Year 1 - The Sacrament of Confirmation (gr. 9-12)
Year 2 - The Sacrament of Confirmation (gr. 10-12)
Year 1 - RCIA Teens
Year 2 - RCIA Teens

Full Name of Student #1: *

Grade: (Current Grade) S1 *

Date of Birth: S1 *

Age: S1 *

Sex: S1 *

Male
Female

School Attending: S1 *

Is Child Baptized: S1 *

Yes
No

Medical Conditions/Allergies: S1 *

Yes
No

Medical Conditions/Allergies: (if yes, explain) S1

Special Educational Needs: S1 *

Yes
No

Special Educational Needs: (if yes, explain) S1

If your child attended last year, name of parish he/she attended (S1)

Documents (Upload) S1

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STUDENT # 2

Program (S2)

Year 1 - The Sacrament of 1st Communion (gr. 1-8)
Year 2 - The Sacrament of 1st Communion (gr. 2-12)
Year 1 - The Sacrament of Confirmation (gr. 9-12)
Year 2 - The Sacrament of Confirmation (gr. 10-12)
Year 1 - RCIA Teens
Year 2 - RCIA Teens

Full Name of Student #2:

Grade: (Current Grade) S2

Date of Birth: S2

Age: S2

Sex: S2

Male
Female

School Attending: S2

Is Child Baptized: S2

Yes
No

Medical Conditions/Allergies: S2

Yes
No

Medical Conditions/Allergies: (if yes, explain) S2

Special Educational Needs: S2

Yes
No

Special Educational Needs: (if yes, explain) S2

If your child attended last year, name of parish he/she attended (S2)

Documents (Upload) S2

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STUDENT # 3

Program (S3)

Year 1 - The Sacrament of 1st Communion (gr. 1-8)
Year 2 - The Sacrament of 1st Communion (gr. 2-12)
Year 1 - The Sacrament of Confirmation (gr. 9-12)
Year 2 - The Sacrament of Confirmation (gr. 10-12)
Year 1 - RCIA Teens
Year 2 - RCIA Teens

Full Name of Student #3

Grade: (Current Grade) S3

Date of Birth: S3

Age: S3

Sex: S3

Male
Female

School Attending: S3

Is Child Baptized: S3

Yes
No

Medical Conditions/Allergies: S3

Yes
No

Medical Conditions/Allergies: (if yes, explain) S3

Special Educational Needs: S3

Yes
No

Special Educational Needs: (if yes, explain) S3

If your child attended last year, name of parish he/she attended (S3)

Documents (Upload) S3

Click or drag files to this area to upload. You can upload up to 3 files.

Upload or take a picture

FATHER'S INFORMATION

Father's Name

Father's Cell Phone

Father's Religion

MOTHER'S INFORMATION

Mother's Name

Mother's Cell Phone

Mother's Religion:

Emergency Contact 1

Name (Emergency 1) *

City (Emergency 1) *

Phone (Emergency 1) *

Relationship to child (Emergency 1) *

Emergency Contact 2

Name (Emergency 2) *

City (Emergency 2) *

Phone (Emergency 2) *

Relationship to child (Emergency 2) *

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 2020-2021 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.

Empowering God’s Children (Virtus) *

Virtus Acknowledgement

Parent Permission Slip for the VIRTUS® Teaching Touching Safety Program... I understand that for my child to participate in the Empowering God’s Children Safety Program I need to fill out and return this Parent Permission Form at the time of registration. My signature below is my specific request for my child’s participation in the Empowering God’s Children Safety Program. For all students on this registration. http://olphdowney.com/wp-content/uploads/2020/10/2020-2021-Empowering-God’s-Children-Safety-Program.pdf

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..... http://olphdowney.com/wp-content/uploads/2020/10/2020-2021-Parent’s-Authorization-to-Use-Child’s-Image.pdf

Total

$ 0.00