2022 Spring Pueri Cantores Registration

2022 Fall Youth Choir Registration

Rehearsals begin August 15th
Choir rehearsal begins on August 15th.
- Pueri Cantores (boys and girls in grades 1-5) 5:00pm-5:45pm
- Bella Voce (girls grades 6-12)
Total Number of Children Registering*
Parent/Guardian Name*

First NameLast Name
Cell Phone # for Communications *
Email Address for Communications*

Confirmation EmailEmail Address

Child #1 Information
Child #1 Name*

First NameLast Name
Sex*
Date of Birth*

MonthDayYear
Allergies, Medications (with dosage), or Other Special Medical Issues*
Type "None" in the box, if there are no special medical issues.
Grade Level in School 2021-2022 School Year*
Media Release*

I consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.I do not consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.

Child #2 Information
Child #2 Name*

First NameLast Name
Sex*
Date of Birth*

MonthDayYear
Allergies, Medications (with dosage), or Other Special Medical Issues*
Type "None" in the box, if there are no special medical issues.
Grade Level in School 2021-2022 School Year*
Media Release*

I consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.I do not consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.

Child #3 Information
Child #3 Name*

First NameLast Name
Sex*
Date of Birth*

MonthDayYear
Allergies, Medications (with dosage), or Other Special Medical Issues*
Type "None" in the box, if there are no special medical issues.
Grade Level in School 2021-2022 School Year*
Media Release*

I consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.I do not consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.

Child #4 Information
Child #4 Name*

First NameLast Name
Sex*
Date of Birth*

MonthDayYear
Allergies, Medications (with dosage), or Other Special Medical Issues*
Type "None" in the box, if there are no special medical issues.
Grade Level in School 2021-2022 School Year*
Media Release*

I consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.I do not consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.

Child #5 Information
Child #5 Name*

First NameLast Name
Sex*
Date of Birth*

MonthDayYear
Allergies, Medications (with dosage), or Other Special Medical Issues*
Type "None" in the box, if there are no special medical issues.
Grade Level in School 2021-2022 School Year*
Media Release*

I consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.I do not consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.

Medical Information
Medical/Hospital Insurance Carrier*
If you do not currently have Medical Insurance, type "None" in the box.
Name of Policy Holder
Policy Number
Group Number
Emergency Contact*
Emergency Medical Treatment Release: In the event of an emergency, by initialing below, I hereby give permission to transport my child(ren) to a hospital for emergency medical attention and grant permission for non-prescription medications to be given, if deemed appropriate. (Any prescription medication to be given must be accompanied by a physician’s prescription or a parent note which should be provided separately). I wish to be advised prior to any further treatment by the doctor and hospital. If you are unable to reach me, my spouse, or the other designated guardian, contact the Backup Emergency Contact above.
Assumption of Risk Related to COVID-19: St. Catherine of Siena Parish has put preventative measures in place to reduce the spread of COVID-19; however, the parish cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending activities on the campus of St. Catherine of Siena Parish could increase your risk and that of your children for contracting COVID-19. While St. Catherine of Siena Parish will make all reasonable efforts to lower the risk of COVID-19 exposure and spread at the parish, the parish is unable to provide any guarantee that students or their families will not be exposed to or infected by COVID-19. By enrolling your child(ren) in and attending parish faith formation, you acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you, your child(ren) and or other family members may be exposed to or infected by COVID-19. It is expected that students and other family members will follow the preventative measures and guidelines implemented by St. Catherine of Siena Parish including not coming to the parish premises if demonstrating any signs or symptoms of COVID-19.
Medical Release and Assumption of Risk Related to COVID-19 Approval (please initial to approve the above statements)*
Should be Empty:

2022 Fall Youth Choir Registration