Saint Francis Parish - CCD/Religious Education Registration

CCD/Religious Education Registration

Thank you for registering your child(ren) for CCD. Please note if you are not a St. Francis parishioner, you will need a letter from your home parish with permission to participate in our CCD program. Additionally, all registrants will need: 1) the Parish location and years if your child participated in a CCD program elsewhere. 2) Sacrament certificates stating the parish, month/year, city if your child(ren) received sacraments outside of St. Francis. If you have any questions, please contact the parish office at ccd@stfrancishoboken.net or call 201-659-1772. Thank you.
Are you currently a member of St. Francis Parish?*

YesI am a registered parishioner of a different parishI am not a registered parishioner of any parish
What is your envelope number?*
If you do not know your envelope number please contact the parish office @ 201-659-1772
Please have copies of your child(ren)'s out-of-parish baptism and/or communion cerftificates to complete this registration
Name of parish are you registered in*
Parish phone number*

Parent/Guardian/Custodian/Other Information
Your relationship to child(ren) being registered:

ParentGuardianCustodial parentother (grandparent, aunt, uncle, etc.)
Parent/guardian/custodian/other name*

First NameLast Name
Parent/guardian/custodian/other email*
example@example.com
Parent/guardian/custodian/other cell number*
Please enter a valid phone number.
Parent/guardian/custodian/other home phone number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency contact*

First NameLast Name
Emergency contact phone number*
Please enter a valid phone number.
Relationship to child(ren)*

Number of Children to be Registered
For more than 3 children please contact the parish office at ccd@stfrancishoboken.net or call 201-659-1772
How many children are you registering?*

123

Child Registration - Information
Child's name*

First NameLast Name
Child's age*
Child's date of birth*

MonthDayYear
City of birth*
State of birth*
County of birth (***NOT COUNTRY***)*
Name of school child is currently attending*
Child's grade as of September*

If your child received any of their sacraments at St. Francis you only need to fill in the year(s) they were received. If your child did not receive a sacrament at St. Francis please fill out all fields below for that sacrament. You will be given the opportunity to submit a copy of the certificate(s) later in the registration process.*

	Month/Year	Church name	City/State
Baptized
First Reconciliation
First Communion

Out-of-parish baptism & communion cerftificates must be submitted to St. Francis Church before your child(ren)'s registration is finalized
Has your child attended religious education at a parish other than St. Francis?*

YesNo

Does your child have any learning disabilities?*

YesNo
Please describe*
Any allergies?*

YesNo
Please describe*
food, bee sting, etc.
Would you like to register another child?*

YesNo

	Year(s)	Church name	Church city/state
Religious education

Child #2 Registration - Information
Child #2 name*

First NameLast Name
Child #2 age*
Child #2 date of birth*

MonthDayYear
City of birth*
State of birth*
County of birth (***NOT COUNTRY***)*
Name of school child #2 is currently attending*
Child #2 grade as of September*

If child #2 received any of their sacraments at St. Francis you only need to fill in the year(s) they were received. If child #2 did not receive a sacrament at St. Francis please fill out all fields below for that sacrament. You will be given the opportunity to submit a copy of the certificate(s) later in the registration process.*

	Month/Year	Church name	City/State
Baptized
First Reconciliation
First Communion

Out-of-parish baptism & communion cerftificates must be submitted to St. Francis Church before your child(ren)'s registration is finalized
Has child #2 attended religious education at a parish other than St. Francis?*

YesNo

Does child #2 have any learning disabilities?*

YesNo
Please describe*
Any allergies?*

YesNo
Please describe*
food, bee sting, etc.
Would you like to register another child?*

YesNo

	Year(s)	Church name	Church city/state
Religious education

Child #3 Registration - Information
Child #3 name*

First NameLast Name
Child #3 age*
Child #3 date of birth*

MonthDayYear
City of birth*
State of birth*
County of birth (***NOT COUNTRY***)*
Name of school child #3 is currently attending*
Child #3 grade as of September*

If child #3 received any of their sacraments at St. Francis you only need to fill in the year(s) they were received. If child #3 did not receive a sacrament at St. Francis please fill out all fields below for that sacrament. You will be given the opportunity to submit a copy of the certificate(s) later in the registration process.*

	Month/Year	Church name	City/State
Baptized
First Reconciliation
First Communion

Out-of-parish baptism & communion cerftificates must be submitted to St. Francis Church before your child(ren)'s registration is finalized
Has child #3 attended religious education at a parish other than St. Francis?*

YesNo

Does child #3 have any learning disabilities?*

YesNo
Please describe*
Any allergies?*

YesNo
Please describe*
food, bee sting, etc.

	Year(s)	Church name	Church city/state
Religious education

Out-of-Parish Certificates
Out-of-parish baptism & communion cerftificates must be submitted to St. Francis Church before your child(ren)'s registration is finalized
I have copies of my child(ren)'s out-of-parish certificates and would like to upload them nowI will provide copies of my child(ren)'s out-of-parish certificates to St. Francis Church later
Use the field below to upload out-of-parish sacrament records for your child(ren).

JPG, PDF, Word doc, photo, screencap, etc.
Cancelof

EpiPen Information
Do any of the children being registered require an EpiPen?*

YesNo

St. Francis Church - EpiPen Consent
I consent to the administration of the epinephrine via a pre-filled auto-injector mechanism according to the following option: (Please select your choice.)
OPTIONS*

Option A: The parents/guardians understand that they must provide the pre-filled auto-injector containing epinephrine. Parents may send the medication at each session or leave the medication with the Parish Catechetical Leader for the duration of the catechetical year. If the parents/guardians leave the medication for the duration for the program year, they understand that they are responsible for replacing the medication when it expires or when otherwise necessary. They agree to pick up any unused medication at the end of the school year, when the medication become outdated, or when the medication become outdated, or when the medication is no longer necessary, whichever comes first. The student’s prescribed epinephrine shall be placed in a secure but unlocked location easily accessible by the medical professional, designee or parent/guardian to ensure prompt availability in the event of an allergic emergency at the parish program or related activity.Option B: The parents/guardians understand that they must provide the pre-filled auto-injector containing epinephrine as outlined in Option A above. The student may carry the prescribed epinephrine in a secure manner that is also easily accessible by the medical professional, designee or parent/guardian to ensure prompt availability in the event of an allergic emergency at the parish program or related activity.Option C: In Cases where the parents/guardians, or a “designee” selected by the parents/guardians, are on premises to administer the epinephrine, they understand that they are responsible for bring the pre-filled auto-injector with them to every session and take it home with them after every session. In cases where the parents/guardians, or a “designee” selected by the parents/guardians, are the premises to administer the epinephrine, they understand that they are responsible for having the pre-filled auto-injector containing epinephrine on their person at all times while present at program sessions.
Name of child #1 that requires EpiPen*

First NameLast Name
Name of child #2 that requires EpiPen

First NameLast Name
Name of child #3 that requires EpiPen

First NameLast Name
I acknowledge that the parish and its employees and agents shall have no liability as a result of any injury arising from the administration of the epinephrine via a pre-filled auto-injector mechanism to the student and that the parents/guardians shall indemnify and hold harmless the parish and its employees or agents against any claims arising out of the administration of the epinephrine via a pre-filled auto-injector mechanism to the student.
I confirm I have read & understood the St. Francis Church EpiPen consent.
Parent/guardian/custodian/other name*

First NameLast Name
Parent/guardian/custodian/other signature*

Clear

Acknowledgement of St. Francis Religious Education Handbook
Child #1*

First NameLast Name
Child #2

First NameLast Name
Child #3

First NameLast Name
Acknowledgement

I hereby acknowledge that I have read the policies and procedures contained in the St. Francis Religious Education Handbook. I further acknowledge that I understand these policies and procedures, that I have discussed them with my child(ren), and that I/we will act in accordance with them.
Parent/guardian/custodian/other name*

First NameLast Name
Parent/guardian/custodian/other signature*

Clear

Photograph/Videography Policy Archdiocese of Newark

All parents/guardians are required to grant or deny permission for St. Francis’ digital media policy. The form will be kept in each child’s CCD file.
Child #1*

First NameLast Name
Child #2

First NameLast Name
Child #3

First NameLast Name
Please select one of the below choices:*

I/We DO grant permission for a photo/image or first name of this student to be published on St. Francis Church Social Digital Media accounts. (Including but not limited to the parish website, Facebook, Twitter and YouTube). I realize the photo may be published in the newspaper, magazine, the parish website, or other publications. The video may be used for information or educational purposes regarding the programs or curriculum at St. Francis Religious Education Program. Also, the photographs may be used around the church and in the classrooms.I/We DO NOT grant permission for a photo/image or first name of this student to be published on St. Francis Church Social Digital Media accounts. (Including but not limited to the parish website, Facebook, Twitter and YouTube). I realize the photo may not be published in the newspaper, magazine, the parish website, or other publications. The video may not be used for information or educational purposes regarding the programs or curriculum at St. Francis Religious Education Program. Also, the photographs may not be used around the church and in the classrooms.
By choosing that I DO grant permission, I confirm I have read & understood the Archdiocese of Newark/St. Francis’ Photograph/Videography Policy as noted below.
I have read the policy and understand the contents of this consent. I am waiving and relinguishing all rights. I also understand that this consent will remain in effect unless and until revoked by me in writing and communicated to St. Francish.
Parent/guardian/custodian/other name*

First NameLast Name
Parent/guardian/custodian/other signature*

Clear
Digital Communication Policy - St. Francis Church/Archdiocese of Newark

All parents/guardians are required to review the Archdiocese of Newark/St. Francis’ digital communication policy.
Child name #1*

First NameLast Name
Child name #2

First NameLast Name
Child name #3

First NameLast Name
I confirm I have read & understood the Archdiocese of Newark/St. Francis’ Digital Communication Policy.
Parent/guardian/custodian/other name*

First NameLast Name
Parent/guardian/custodian/other signature*

Clear
Donation: $100 per family ($125 for more than one child)

Only one donation per family required. The donation is $100 for families with one child; the donation for families with more than child is a flat fee of $125.
I understand that a donation of $100.00 per family with one child or $125 for families with more than one child will be made to St. Francis Parish.

Donation must be received by St. Francis Parish before your child(ren)'s registration is finalized.
I intend to pay by:*

Venmo @StFrancis-Church (look for St. Francis Church logo) NOTE: please indicate CCDParish Giving (see website for direct payment link)Check
Checks should be made out to:
St. Francis Parish (CCD on comment line)

...and can be mailed to:
St. Francis Parish
308 Jefferson Street
Hoboken, NJ 07030
Attn: Religious education
Parent/guardian/custodian/other name*

First NameLast Name
Parent/guardian/custodian/other signature*

Clear
Should be Empty:

CCD/Religious Education Registration

Parent/Guardian/Custodian/Other Information

Number of Children to be Registered

Child Registration - Information

Child #2 Registration - Information

Child #3 Registration - Information

Out-of-Parish Certificates

EpiPen Information

St. Francis Church - EpiPen Consent

Acknowledgement of St. Francis Religious Education Handbook

Donation: $100 per family ($125 for more than one child)