In the event a parent cannot be reached, please list the names, relationships, addresses, and telephone numbers of two local persons, other than parents, whom you authorize to assume custody of your child in case of an emergency or disaster. Please select people who are close to St. Joseph of Cupertino.
In case of minor illness or injury, first aid will be administered. If serious illness or injury occurs, we will attempt to notify the parent/guardian. If we are unable to reach you, we must have the following authorization signed. “I authorize any duly licensed physician or surgeon to administer necessary treatment to my child.”
Parent/Legal Guardian's Full Name: First Name* Last Name*
Signature: Signature* Date: Date*
RELEASE: I REQUEST THAT ST. JOSEPH OF CUPERTINO CHURCH OF THE ROMAN CATHOLIC DIOCESE OF SAN JOSE, PERMIT MY CHILD(REN) TO PARTICIPATE IN THE FAITH FORMATION, YOUTH MINISTRY, SACRAMENTAL PREPARATION PROGRAMS AND /OR YOUTH RETREATS TO BE HELD AT ST. JOSEPH OF CUPERTINO CHURCH, ST. JOSEPH OF CUPERTINO CATHOLIC SCHOOL FROM AUGUST 2021 THROUGH JULY 2022. I UNDERSTAND THAT REASONABLE PRECAUTIONS WILL BE TAKEN TO SAFEGUARD THE HEALTH AND WELL-BEING OF MY CHILD(REN) INCLUDING PRECAUTIONS FOR COVID-19, AND THAT I WILL BE NOTIFIED AS SOON AS POSSIBLE IN THE EVENT OF AN EMERGENCY. IN CASE OF SICKNESS OR ACCIDENT, I AUTHORIZE AND CONSENT TO ANY X-RAY EXAM, ANESTHETIC, MEDICAL, OR DENTAL TREATMENT AND HOSPITAL CARE TO BE RENDERED TO MY CHILD(REN) UNDER THE GENERAL CARE AND ADVICE OF ANY PHYSICIAN, DENTIST OR SURGEON LICENSED TO PRACTICE IN ANY STATE. I FURTHER UNDERSTAND AND AGREE TO BE RESPONSIBLE FOR ANY SUCH MEDICAL, DENTAL AND/OR HOSPITAL EXPENSES INCURRED AND I AGREE TO INDEMNIFY AND HOLD THE DIOCESE HARMLESS FOR ANY INJURY OR DAMAGE MY CHILD(REN) MAY SUSTAIN IN PARTICIPATION.
Parent/Legal Guardian's Full Name: First Name* Last Name* Signature: Signature* Date: Date
Please type in either "GRANT PERMISSION" or "DO NOT GRANT PERMISSION"
I hereby (select below: "Grant Permission" or "Do Not Grant Permission") to St. Joseph of Cupertino Church to videotape/ photograph my child and without limitation, to use such photos, videos and/or stories in connection with any of the work of St. Joseph of Cupertino Church without consideration of any kind, and I do hereby release the parish, the Pastor, the parish employees and volunteers from any and all claims whatsoever which may arise in said regard.
St. Joseph of Cupertino Catholic Parish agrees that only the student's picture, art, voice, verbal statements, portraits (video or still) shall only be used for public relations, public information, parish promotion, publicity, and instruction. St. Joseph of Cupertino Catholic Parish further agrees that children under the age of 18 years who appear in a photograph or video will not be identified by any personal details such as name, address (e-mail or postal), telephone or fax numbers, or classroom assignment.
St. Joseph of Cupertino Catholic Parish will immediately comply with any request by a parent or legal guardian for the removal of specific photographs featuring their child or references to their child’s name. Keep in mind that St. Joseph of Cupertino Catholic Parish has no control over media/pictures/statements which are taken by anyone other than our parish employees and volunteers.
Student and Parent/Guardian understand and agree that photos, videos and/or student statements may be used in subsequent years.
If the Student and/or Parent/Guardian wish to rescind this agreement they may do so at any time with written notice.
Parent/Legal Guardian's Full Name: First Name* Last Name* Signature: Signature* Date: Date*
Parish program(s) are providing virtual programming and content for its participants, through which staff will facilitate program activities through online platforms. The program(s)will use software, tools and applications provided by third-parties that participants, parents/legal guardians, volunteersand/or staff will access via the internet and use for purposes of communication and programming and potential content creation. These platforms may include but are not limited to Zoom, GoToMeeting, Google Classroom, Facebook, YouTube, etc.This Form provides your consent and release for your child to participate in the program(s)and utilize theseonline applications for distance-based, virtual program purposes. Please be aware that each application collects different informationabout its users and has its own privacy terms and conditions to which members must adhere and which parish or diocese cannot control or assume responsibility. Please review these carefully before registering your child.Our commitment to keeping the children and youthwe serve safe is always our number one priority. To that end, we will actively monitor participant activity. All online activities contemplated hereunder must also comply with the Diocese of San Jose Safe Environment and Technology Policies including the Code of Conduct guidelines and the Diocesan Social Media policy.Below, please find your AUTHORIZATION, CONSENT AND RELEASE FOR SOCIAL MEDIA OR OTHER ELECTRONIC COMMUNICATION INVOLVING MINORS FORM.
Parent/Legal Guardian's Full Name: First Name* Last Name* Email: Email* Phone Number: Area Code* Phone Number* Address: Street Address* City* State* Zip*
TO THE EXTENT PERMITTED BY LAW, I HOLD THE PARISH/SCHOOL AND DIOCESE OF SAN JOSE HARMLESS FROM ANY CLAIM OF INJURY, SICKNESS, ILLNESS OR DAMAGE THAT I/MY CHILD MAY SUFFER OR SUSTAIN DURING THE PROGRAM LISTED ABOVE, WITH EXCEPTION TO INJURY OF DAMAGES ARISING OUT OF THE SOLE NEGLIGENCE OF THEPARISH/SCHOOLOR DIOCESE OF SAN JOSE. I ATTEST THAT I AM/MY CHILD IS PHYSICALLY FIT TO PARTICIPATE IN THIS PROGRAM.
IN THE EVENT THAT I/MY CHILD BECOME(S) ILL OR INJURED, I DO HEREBY CONSENT TO WHATEVER MEDICAL TREATMENT(S), INCLUDING BUT NOT LIMITED TO X-RAY, EXAMINATION, OR HOSPITAL CARE,CONSIDERED NECESSARYIN THE BEST JUDGEMENT OF THE ATTENDING PHYSICIAN AND PERFORMED BY OR UNDER THE SUPERVISION OF A MEMBER OF THEMEDICAL STAFF OF THE HOSPITALAND/OR OTHER MEDICALFACILITY PROVIDING THE TREATMENT. I AM NOT AWARE OF ANY MEDICAL CONDITION WHICH WOULD RENDER IT INAPPROPRIATE FOR ME/MYCHILD TO PARTICIPATE IN ANY ACTIVITY ASSOCIATED WITH THE PROGRAM.
Further, the novel coronavirus, COVID-19, is a highly infectious, life-threatening disease declared by the World Health Organization to be a global pandemic. COVID-19’s highly contagious nature means that contact with others, or with surfaces that have been exposed to the virus, can lead to infection. Additionally, individuals who may have been infected with COVID-19 may be asymptomatic for a period of time or may never become symptomatic at all. Because of its highly contagious and sometimes “hidden” nature, it is currently very difficult to control the spread of COVID-19 or to determine whether, where, or how a specific individual may have been exposed to the disease.
Therefore, I acknowledge the contagious nature ofCOVID-19 and the fact that it can be difficult to identify in another person, and the inherent risks of exposure at this programto those who may be infected with COVID-19. I voluntarily assume the risk that I/my child may be exposed to or infected by COVID-19, or other infectious virus or disease,by participating in this event and that such exposure or infection may result in personal injury, illness, permanent disability, and/or even death.I/my childfurther acknowledge that the CDC and many other public health authorities continue to recommend social distancing and other protective measures to prevent the spread of COVID-19. I/my child acknowledge that I/my child must comply with all set procedures to reduce the spread of COVID-19 while Participating.I/my childunderstand that the PARISH/SCHOOL AND DIOCESE OF SAN JOSEhaveput in place new rules and precautions in order to mitigate the spread of COVID-19, which rules and precautions may be updated at any time. While acknowledging that these rules andprecautions may or may not be effective in mitigating the spread of COVID-19, I/my childagree to comply with such rules and precautions which may include, but are not limited to, wearing a face covering, hand washing, hand sanitizing, and social distancing. I/my child understand and acknowledge that given the unknown nature of COVID-19, it is not possible to fully list each and every individual risk of contracting COVID-19. I/my child understand that the risk of becoming exposed to or infected by COVID-19 during my Participantservice may result from the actions, omissions, or negligence of myself and others, including, but not limited to, priests, parish/school/diocesan staff, Participants, and other parish/school/diocesan workers, including their families. I/my childrecognize that the PARISH/SCHOOL AND DIOCESE OF SAN JOSE cannot limit all potential sources of COVID-19 infection and cannot guarantee that I/my child will not become infected with COVID-19.I/my childvoluntarily serve(s)the PARISH/SCHOOL AND DIOCESE OF SAN JOSE and I acknowledge that, by serving,I am/my child isincreasing the risk ofexposure to COVID-19.I/my childvoluntarily assume full responsibility for any and all risks of illness or injury associated with my/my child’s exposure to COVID-19,or other infectious virus or disease,as well as from use of any protective equipment, including face coverings, that the PARISH/SCHOOL AND DIOCESE OF SAN JOSE may voluntarily provide to me/my child.
Before I bring my child to the program Ihereby attest that:
1. I am/my child isnot experiencing any symptomsof illness such as cough, shortness of breath or difficulty of breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
2. Ihave/my child hasnot traveled internationally within the last 14 days.
3. I have/my child hasnot traveled to a highly impacted area within the United States of America in the last 14 days.
4. I do not believe I have/my child hasbeen exposed to someone with asuspected and/or confirmed case of COVID-19.
5. I have/my child hasnot been diagnosed with COVID-19and not yet cleared as non-contagious by state or local public health authorities.
6. I/my childam/isfollowing all CDC recommended guidelines and limiting my/my child’sexposure to COVID-19.
I/my child understand that this release discharges the PARISH/SCHOOL AND DIOCESE OF SAN JOSE from any liability or claim that I/my child, my heirs, or any personal representatives may have against the parish with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any Participantservices provided to the PARISH/SCHOOL AND DIOCESE OF SAN JOSE. This liability waiver and release extends to the PARISH/SCHOOL AND DIOCESE OF SAN JOSE together with its clergy, staff, and other Participants.
Parent/Legal Guardian's Full Name: First Name* Last Name* Signature: Signature* Date: Date*
School Year Tuition (Kinder-8th Grade):
$100.00 - One child$150.00 - Two children$200.00 - Three or more children
Sacramental Preparation Tuition:
$50.00 (is in addition to the school year tuition) - 2nd Grade "Restored Order"* $50.00 (is in addition to the school year tuition)- Confirmation Only**
You will be invoiced in late September unless you request financial aid. Full or partial financial aid is also available to families upon request.
After you hit "summit" you will be redirected to our Catechetical Ministry's "Pay Fees Online" payment option.
You will have the to make a payment at that time or you may choose to pay later.
*2nd Grade "Restored Order" are children who are in 2nd grade and have already completed one year of Sunday School program. Children who have completed one year of Sunday School and are entering the 2nd grade are eligible to receive the Sacraments of Confirmation & 1st Communion at the end of the school year.
**"Confirmation Only" are children who are in the 3rd grade (minimum 8 years old) and up and have received their 1st Communion but have not recieved their Sacrament of Confirmation.
For more information you may contact Daniel Gutierrez, Director of Catechetical Ministry, by phone: 408.252.7653 x 141 or by email: email@example.com