Reg. Teen RCIA 2023-2024 Please enable JavaScript in your browser to complete this form.Student Name *FirstMiddleLastParent's Email - Main Contact *Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of Birth *Age *Gender *School Grade (as of aug. 2024) *School Attending *Is Child Baptized *YESNOTeen RCIA *Year 1 (click here if this is your teen’s first year attending) - $ 250.00Year 2 (click here if your teen attended last year) - $ 280.00High School teens grades 9 – 12. Baptized and unbaptized teens who have not celebrated the Sacrament of First Holy Communion and Confirmation.Medical Conditions *YESNOAllergies *YESNOSpecial Needs *YESNOList any Medical Conditions/Allergies/Special NeedsName of Parish if student attended last yearPARENT INFORMATIONFather's Name *Father's Cell Phone *Father's Religion *Mother's Name *Mother's Cell Phone *Mother's Religion *EMERGENCY CONTACT INFORMATIONList 2 Persons Other Than ParentsEmergency Contact #1 *Other Than ParentsCity (E1) *Cell Phone (E1) *Relationship to Child (E1) *Emergency Contact #2 *Other Than ParentsCity (E2) *Cell Phone (E2) *Relationship to Child (E2) *Medical Release *Emergency AcknowledgementI 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.pdfBirth Certificate *Please upload Birth CertificateBaptismal Cert. *Please upload Baptismal certificateTotal$ 0.00Submit