Religious Education K-9th Registration 2023-24

St. Therese Catholic Church
Religious Education Registration 2023/2024 Grades K-9th Grade

DUE SEPTEMBER 4th
Date

MonthDayYear
Parent/Guardian Name
Last Name*
First Name*
Street Address Line 2*
City*
State*
Zip Code*
Email Address*
Cell Number*
Parent/Guardian Information
Mom's Name*
Parish Membership*
Dad's Name*
Parish Membership*

Emergency Contact (someone other than Mom or Dad or Legal Guardian)
Last Name*
First Name*
Phone Number*

Area CodePhone Number
Physician and Medical Information
Last Name*
First Name*
Primary Phone Number*
Secondary Phone Number
Preferred Hospital*
Insurance/Health Coverage (Company)*

Children's Information
Name*

First NameLast Name
Please check mark the Sacraments your child has received
Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns (ADHD, Dyslexia, Autism, etc. . .) Also please provide important information regarding classroom - if they struggle with anything or experience difficulties with certain things - this are very helpful to the teacher and DRE.
Children's Information
Name

First NameLast Name
Please check mark the Sacraments your child has received
Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns (ADHD, Dyslexia, Autism, etc. . .) Also please provide important information regarding classroom - if they struggle with anything or experience difficulties with certain things - this are very helpful to the teacher and DRE.
Children's Information
Name

First NameLast Name
Please check mark the Sacraments your child has received
Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns (ADHD, Dyslexia, Autism, etc. . .) Also please provide important information regarding classroom - if they struggle with anything or experience difficulties with certain things - this are very helpful to the teacher and DRE.
Children's Information
Name

First NameLast Name
Please check mark the Sacraments your child has received
Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns (ADHD, Dyslexia, Autism, etc. . .) Also please provide important information regarding classroom - if they struggle with anything or experience difficulties with certain things - this are very helpful to the teacher and DRE.
Children's Information
Name

First NameLast Name
Please check mark the Sacraments your child has received
Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns (ADHD, Dyslexia, Autism, etc. . .) Also please provide important information regarding classroom - if they struggle with anything or experience difficulties with certain things - this are very helpful to the teacher and DRE.
A new change to this year is that if you are NOT a registered member of St. Therese parish, the cost for religious education is $40 per child. If you are currently not a registered member of St. Therese and would like to become a registered member, please email Deacon Thane @ reddirector@sttheresesf.org to obtain the form to fill out to become a member.

If you wish for your child to attend religious education but do not wish to register at St. Therese, please mail/drop off your check to the parish.

Checks made out to: St. Therese Parish & mark religious education

Cost: $40 per child

Your child(ren) WILL NOT be able to participate in religious education until the payment has been received. Again, payment only pertains to those families who are NOT registered members of St. Therese Parish.
Please indicate which grade(s) your child(ren) will be in starting Fall 2021.*
This form covers events for the Religious Education program of St. Therese Parish for the 2022-2023 school year. The Religious Education curriculum may include: field trips, service in the community, events and classes on and off the property of St. Therese, photography (this includes potential posting of a picture on social media: Facebook, Instagram, Twitter, YouTube, Parish Website. Permission to treat in case of an emergency. To participate in this parish youth ministry/religious education event that requires transportation to a location away from the parish site. This activity will take place under the guidance and direction of parish employees and/or volunteers from St. Therese Parish. As a parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("participant"). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Therese Parish, its officers, directors and agents, and the Catholic Diocese of Sioux Falls, chaperones, or representatives associated with the event, arising from or in connection with my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Catholic Diocese of Sioux Falls, chaperones, or representatives associated with the event for reasonable attorney's fees and expenses arising in connection therewith.
Signature*

Clear
Should be Empty:

Parent/Guardian Name