2022-23 Faith Formation Program New FamilyRegistration Grades 1-11

2022 - 2023 SM & SOZ Religious Education Program New Family Registration Grades 1-11

If your child will be receiving a sacrament this year, please fill out the additional 2022-2023 Sacramental Registration Form.
Date

Month Day Year
Date
Parish Member: *
If nonmember, please list which parish you belong to:
Child(ren) reside(s) with: *
Father
Name

First Name Middle Name Last Name
Religion:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone:
Cell Phone:
Work Phone:
Email
example@example.com
Mother
Name

First Name Middle Name Last Name
Religion:
Address if different from Father

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone:
Cell Phone:
Work Phone:
Email
example@example.com
Guardian(s)
Name

First Name Middle Name Last Name
Name

First Name Middle Name Last Name
Religion:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone:
Cell Phone:
Work Phone:
Email
example@example.com
Preferred Contact Method:

Most group information is sent out via email. This is for if I need to contact you individually.
Preferred Contact Method: *
Child(ren) Registering
Child(ren) Information
Child's Name

First Name Last Name

Sacramental Information

	Yes	No	Received at St. Mary or Sons of Zebedee
Baptized
First Reconcilliation
First Communion
Confirmation

Child's Name

First Name Last Name

Sacramental Information

	Yes	No	Received at St. Mary or Sons of Zebedee
Baptized
First Reconcilliation
First Communion
Confirmation

Child's Name

First Name Last Name

Sacramental Information

	Yes	No	Received at St. Mary or Sons of Zebedee
Baptized
First Reconcilliation
First Communion
Confirmation

A copy of the baptismal certificate for each child registering is required of all new students not baptized at St. Mary or Sons of Zebedee
If the sacrament was not received at St. Mary- Lomira or Sons of Zebedee St. James & St. John, please list the church and city the sacraments were received.
Please upload your child's baptismal certificate(s) here:

Browse Files

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WHAT ARE THE TUITION FEES?

Registration Fees are as follows:

Number of Children	St. Mary & Sons of Zebedee Parish Members	Non-parish Member
1	$65.00	$130.00
2	$115.00	$230.00
3+	$155.00	$310.00

*Tuition does not include retreat fees or sacramental fees and is nonrefundable.

HOW DO I PAY MY TUITION FEES?

Payment should be sent upon completion of this form.

Completed forms/payment DUE August 1st, 2022

Memo line of check: REL ED FEES

Mail payment to: St. Mary Parish, Attn: DRE 699 Milwaukee St., Lomira, WI 53048

Drop payment in collection in a plain (noncontribution) envelope: Attn: Lesa Staehler, DRE

Drop envelope with a payment in the SM Parish Office Mail Slot: Attn: Please give to Lesa Staehler, DRE
Volunteer Discount: Anyone who volunteers as a Catechist, Aide, or Hall Monitor will receive a discount on religious education fees of One Free Tuition of an Immediate Family Member enrolled in grades 1-10. This does not include Sacramental Fees.

Yes I will to Volunteer for the Religious Ed Program Sorry, unavailable
If Yes, Safe Environment Training:

I have completed the Safeguarding God’s Children Training Program in the past
If Yes, Select Volunteer Role
If yes, please include name and best time to contact:
Required Forms

Please complete and electronically sign and date the following forms below.
I give my consent for the following Child(ren)/Youth Communication Methods (check off all that apply) (This mainly applies to middle and high school youth as some prefer to be texted or emailed information regarding class or for them to correspond about missing work, etc. Social Media Platforms would only be used in the event that we are not allowed to meet in-person per an Archdiocese order) *

Phone Text E-mail Social Media Platform (i.e. Google Meet, Zoom, etc.) I DO NOT give my permission for any of the above Child(ren)/Youth Communication Methods to be used with my child.
SIGNATURE OF PARENT/ LEGAL GUARDIAN: *

Clear
Archdiocese of Milwaukee Release of Information *

I consent that any still or electronic image and/or audio recording, in which I or my child may appear, maybe used by St. Mary and Sons of Zebedee Religious Education/Family Faith Program. I understand that these materials are being used for promotion St.Mary and Sons of Zebedee Parishes. The images and/or recordings may be used to support recruitment, fundraising, evangelization and other communication efforts. I release the staff and volunteers and I understand and agree that the use of my picture is not an invasion of privacy. Neither I, nor anyone claiming to be speaking on my behalf, will later object to the use of this/these photographs by the parish. I DO NOT consent to have photographs or videos taken of my children.
Signature of parent or legal guardian *

Clear
Safeguarding God’s Children / Family *

I consent to the participation of my child(ren) in The Safeguarding All of God’s Family lesson. As requirement from the Archdiocese, our children must have one class each year for Safeguarding All of God’s Family. I DO NOT want my child(ren) to participate in The Safeguarding All of God’s Family lesson.
Signature of parent or legal guardian *

Clear
Emergency Contact Information
In the event of a last minute cancellation or medical emergency, please list two phone numbers to contact you (parents):
Name to contact in the event of an emergency *

First Name Last Name
Name to contact in the event of an emergency

First Name Last Name
Phone Number *

Area Code Phone Number
Phone Number

Area Code Phone Number
Other Emergency Contacts (not parents - please list at least one)
Name *

First Name Last Name
Name

First Name Last Name
Phone Number *

Area Code Phone Number
Phone Number

Area Code Phone Number
Relationship to the Parent *
Relationship to the Parent
(OPTIONAL) My child(ren) may be released to the following people (non guardian or parent) at class dismissal:
Name

First Name Last Name
Name

First Name Last Name
Name

First Name Last Name
Name

First Name Last Name
Emergency Medical Treatment *

In the event of an emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by the hospital or doctor
Signature of parent or legal guardian *

Clear
Family email and phone permission to share *

I give permission to have my family’s email and/or phone number with families in our parish i.e. youth fellowship I DO NOT permit my family’s email and/or phone number to be shared
Signature of parent or legal guardian *

Clear
All boxes signed on this date: *

Month Day Year
Date
Should be Empty:

2022 - 2023 SM & SOZ Religious Education Program New Family Registration Grades 1-11

Father

Mother

Guardian(s)

Preferred Contact Method:

Child(ren) Registering

Required Forms

Emergency Contact Information