St. Mark Religious Formation and CYM Registration Grades 1-12
2025-2026
Registration Due:
Monday, August 25, 2025
Registration Fee:
$25.00/student (maximum of $50.00/family).
First Class:
September 3 at 6:30pm (grade school) and 6:45pm (high school)
Questions? Contact Jessie Schoech at
jschoech@stmarkks.org
or 796-1604.
PARENT/GUARDIAN INFORMATION
Parent/Guardian 1
*
First Name
Last Name
Phone Number 1
*
-
Area Code
Phone Number
Parent/Guardian 2
First Name
Last Name
Phone Number 2
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
E-mail
*
EMERGENCY CONTACT
In the event that the Parent(s)/Guardian(s) listed above cannot be reached, please provide at least one alternate Emergency Contact to be called in case of an emergency.
Emergency Contact
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Child #1
Name
*
First Name
Last Name
Grade
*
1
2
3
4
5
6
7
8
9
10
11
12
for 2025-2026 school year
Gender
*
M
F
Birthdate
*
/
Month
/
Day
Year
HIGH SCHOOL ONLY: Phone Number (used for direct reminders and communication from leaders)
-
Area Code
Phone Number
Programs
*
Grade School PSR
High School Formation
High School CYM
Sacraments Received
*
Baptism
Eucharist
Confirmation
None/Not Catholic
Learning/Medical Concerns/Allergies
Child #2
Name
First Name
Last Name
Grade
1
2
3
4
5
6
7
8
9
10
11
12
for 2025-2026 school year
Gender
M
F
Birthdate
/
Month
/
Day
Year
HIGH SCHOOL ONLY: Phone Number (used for direct reminders and communication from leaders)
-
Area Code
Phone Number
Programs
Grade School PSR
High School Formation
High School CYM
Sacraments Received
Baptism
Eucharist
Confirmation
None/Not Catholic
Learning/Medical Concerns/Allergies
Child #3
Name
First Name
Last Name
Grade
1
2
3
4
5
6
7
8
9
10
11
12
for 2025-2026 school year
Gender
M
F
Birthdate
/
Month
/
Day
Year
HIGH SCHOOL ONLY: Phone Number (used for direct reminders and communication from leaders)
-
Area Code
Phone Number
Programs
Grade School PSR
High School Formation
High School CYM
Sacraments Received
Baptism
Eucharist
Confirmation
None/Not Catholic
Learning/Medical Concerns/Allergies
Child #4
Name
First Name
Last Name
Grade
1
2
3
4
5
6
7
8
9
10
11
12
for 2025-2026 school year
Gender
M
F
Birthdate
/
Month
/
Day
Year
HIGH SCHOOL ONLY: Phone Number (used for direct reminders and communication from leaders)
-
Area Code
Phone Number
Programs
Grade School PSR
High School Formation
High School CYM
Sacraments Received
Baptism
Eucharist
Confirmation
None/Not Catholic
Learning/Medical Concerns/Allergies
Child #5
Name
First Name
Last Name
Grade
1
2
3
4
5
6
7
8
9
10
11
12
for 2025-2026 school year
Gender
M
F
Birthdate
/
Month
/
Day
Year
HIGH SCHOOL ONLY: Phone Number (used for direct reminders and communication from leaders)
-
Area Code
Phone Number
Programs
Grade School PSR
High School Formation
High School CYM
Sacraments Received
Baptism
Eucharist
Confirmation
None/Not Catholic
Learning/Medical Concerns/Allergies
PERMISSION
I, the parent/guardian of the participant(s) named above ("child"), request that my child be allowed to participate in, and do hereby give permission for my child to attend and participate in: St. Mark Religious Formation and CYM (2025-2026)
Permission
*
I agree
MEDICAL AUTHORIZATION
I understand that the Catholic Diocese of Wichita and the Parish of St. Mark the Evangelist assumes no responsibility for accidents which may occur in association with diocesan events and activities. I agree to use my personal insurance to cover any such incidents. I understand that, in the event medical intervention is needed, every attempt will be made to contact the persons listed above. In the event those individuals cannot be reached, I hereby give permission to the physician or any other qualified medical staff selected by the event leader to hospitalize, secure medical treatment, and/or order injection, anesthesia or surgery for Participant as deemed necessary.
Medical Authorization
*
I agree
INSURANCE INFORMATION
Insurance Company
*
Policy Number
*
Physician Name
*
First Name
Last Name
Physician Phone
*
-
Area Code
Phone Number
PERMISSION FOR OTHER MEDICAL MATTERS
In the event it comes to the attention of the diocesan and/or parish chaperones that my child complains of illness, I grant permission for non-prescription medication (such as Tylenol, lozenges, etc.) to be given to my child.
Other Medical Matters
*
Yes
No
RELEASE OF LIABILITY FOR YOUTH AND ADULTS
I understand all reasonable safety precautions will be taken at all times by the Catholic Diocese of Wichita and the Parish of St. Mark the Evangelist and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to indemnify and hold harmless the Catholic Diocese of Wichita and/or the Parish of St. Mark the Evangelist, its leaders, employees and volunteer staff from any claim arising from or in connection with attending this event.
Release of Liability
*
I agree
CODE OF BEHAVIOR FOR YOUTH AND ADULTS
Code of Behavior: I agree to abide by and/or instruct my child to abide by all rules and regulations as outlined by the aforementioned chaperones/representatives. I agree that if my child fail(s) to abide in any way by the rules, that my child can be dismissed and sent home immediately at my expense. In addition, I agree to the Religious Formation Code of Conduct and Release listed above.
*
Yes
PHOTO RELEASE
I hereby authorize the Parish of St. Mark the Evangelist, and its agents to utilize photographic and/or video images of me or my child by the Parish of St. Mark the Evangelist. In giving my consent, I hereby indemnify and hold harmless the Parish of St. Mark the Evangelist and its agents from any and all responsibility or liability. I understand that I will receive no compensation, should any photograph and/or video of my child be used.
Photo Release
*
Yes
No
PAYMENT
The registration fee for all youth formation activities is $25 per child ($50 maximum per family). Payments can be made to the parish office by cash or check (payable to "St. Mark Parish) or online at https://abundant.co/stmark/give (please select "Religious Education" under the "Fund" dropdown). If you are in need of financial assistance, please contact the parish office.
Signature of Parent/Guardian
*
Name of Parent/Guardian
*
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