SEAS PREP Registration 2022-2023

ST ELIZABETH ANN SETON
CATHOLIC CHURCH
PARISH RELIGIOUS EDUCATION PROGRAM
REGISTRATION FORM 2022-2023

Please fill out the form below -- if you are registering more than two children you will need to complete two forms.

Please contact Katie Allio, Director of Religious Education, at (386) 445-2246, ext 112, or by email (kallio@seaspcfl.org) if you have any questions.

Family Last Name: *

Father's First Name: *

Mother's First Name: *

Family Email Address: *

example@example.com -- if you do not have an email address please put in "N/A"

Home Phone: *

Father's Cell Phone:

Please enter a valid phone number.

Mother's Cell Phone:

Please enter a valid phone number.

Family Home Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Emergency Contact Name: *

Emergency Phone Number: *

Please enter a valid phone number.

Are Both Parents Catholic?

Child #1 Name: *

Child #1 Gender: *

Child #1 Date of Birth: *

Date

Child #1 Grade: *

Is Child #1 Catholic? *

Child #1 Special Needs (Medical, Learning Disabilities, Physical Disabilities, etc) *

Child # 2 Name:

Child # 2 Gender:

Child #2 Date of Birth:

Date

Child #2 Grade:

Is Child #2 Catholic?

Child #2 Special Needs (Medical, Learning Disabilities, Physical Disabilities, etc)

NOTE: if any of your children were baptized outside of this parish, and you have not already supplied us with a copy of each child's baptismal record, you will need to supply a copy for our files.

PREP FEES

Registration/supply fees for the 2021-2022 school year are as follows:

1st Child: $65

2nd Child: $55

3rd Child: $45

Payment plans are available; please do not let a child be left out due to financial reasons. Contact Mrs. Allio at the Rectory Office for assistance (kallio@seaspcfl.org)

Payments can be made via cash/check at the Rectory Office or online via our Online Giving site Our Sunday Visitor/OSV (instructions listed below):

Go to the parish web page, www.seaspcfl.org
Click " Online Giving " under the Giving link
Click on the "Online Giving" image on the right of the screen (this takes you to the OSV site)
Log-In if you already have an account, or Create an Account if you do not have an account
Click on the "GIVE NOW" button under the Prep Supply and Book Fees image
Put in the amount, the gift type (one-time) and make sure to enter student's name in the "Notes" box!

Tuition Due *

Signature *

Clear

PLEASE NOTE: Registration is NOT complete until payment is received.

Diocese of St Augustine

Child Photography Release Form

Without compensation, I hereby grant permission to the Catholic Diocese of St. Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video, including livestream) and/or brochures. In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustine and all of their employees and agents, from all claims and liability relating to said photographs.

Name of Parent/Guardian: *

Signature of Parent/Guardian: *

Clear

Date *

Date

Diocese of St Augustine

Assumption of Risk and Waiver of Liability Relating to COVID-19

The novel coronavirus ("COVID-19") has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly through person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. St. Elizabeth Ann Seton Catholic Church has put in place preventative measures to reduce the spread of COVID-19; however, we cannot guarantee that you or your child(ren) will not become infected with COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending programs offered by the parish and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the parish may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, coaches, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)'s attendance at any parish sponsored programming ("claims" On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless St. Elizabeth Ann Seton Catholic Church and the Diocese of St. Augustine, and all of their current, former, and future agents, representatives, religious and employees and related entities (collectively, "the Diocese") of and from the claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of the Diocese, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any parish program.

Signature of Parent/Guardian: *

Clear

Date *

Date

Child's Name (Printed)

Address

City

State

Zip

Telephone

Cell

Email

example@example.com

Print Name of Parent/Guardian

Name of Student

FAMILY INFORMATION

STUDENT #1 - INFORMATION

STUDENT #2 - INFORMATION