Faith Formation 2024-2025 Parental Consent, Information, and Release

St. Luke Faith Formation 2024-2025 Parental Consent, Information, and Release
Program: St. Luke Catholic Church Faith Formation 2024-2025.

Parish: St. Luke Catholic Church - Temple, Texas, a non-profit corporation in the State of Texas, including its employees, contractors, clergy, agents, facilitators, and volunteers.

Diocese: Catholic Diocese of Austin, a non-profit corporation in the State of Texas, including its employees, contractors, clergy, agents, facilitators, and volunteers.
Child (Participant's) Name*

First NameLast Name
CFF (Pre-K - 6th) meets Wednesday evenings.
EKO (7th - 8th) meets Wednesday evenings.
Keysis (9th - 12th) meets Sunday evenings.
Child's Grade*
Has your child been baptized?*

Yes, my child was baptized Catholic.Yes, my child was baptized non-Catholic.No, my child has not been baptized.
What other sacraments has you child received?

First ReconciliationFirst Holy CommunionConfirmation
T-Shirt Size
Name of Parent/Guardian*

First NameLast Name
Phone Number of Parent/Guardian*
Please enter a valid phone number.
Email*
example@example.com
Name of Parent/Guardian

First NameLast Name
Phone Number of Parent/Guardian
Please enter a valid phone number.
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code

Emergency Contact

In case we can not reach you.
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone #*
Please enter a valid phone number.

Physician Information
Physician Name
Physician Address
Physician Phone #

Insurance and Additional Information
Insurance Carrier
Insurance Policy Number
Insurance Address
Insurance Phone #
Other Information Parent(s)/Guardian(s) Choose to provide. (Allergies / Special Needs)

Please read and agree to the following:
1. The undersigned Parent/Guardian represents that they are the parent or legal guardian of Participant (a legal minor) and have full authority under law to sign this document. Parent(s)/Guardian(s) further represents that they agree for Participant listed above to participate in the Program.

2.Parent(s)/Guardian(s) grant their permission for Participant to enroll and participate in the Program.

3. Parent(s)/Guardian(s) acknowledge and agree that:
1. Participant and Parent(s)/Guardian(s) voluntarily seek to participate in the Program;
2. the Program may involve physical activity that involves risk of injury;
3. Participant and Parent(s)/Guardian(s) will abide by all policies and rules established for Program and instructions of those persons facilitating, organizing, or overseeing the Program;
4. Parent(s)/Guardian(s) and Participant are responsible for Participant’s conduct during the Program and are responsible for any damages, claims, or other costs caused by Participant or incurred as a result Participant’s conduct; and
5. if Participant’s conduct is inappropriate, unsafe or detrimental to the Program, other participants or other persons, Parish or the Diocese may suspend or expel Participant from the Program and future Programs.
4. Unless this paragraph is struck and initialed by the undersigned, Parent(s)/Guardian(s) authorize Parish or the Diocese to provide over-the-counter non-prescription pain relievers, cold medicine, and other medications or medical care to Participant at Participant’s request if the Parish or Diocese deem it reasonable to do so. The Parish or Diocese will make reasonable attempts to notify Parent(s)/Guardian(s) prior to authorizing any such non-prescription medication or medical care.
Do you wish to strike Paragraph 4 above?
Initials to strike Paragraph 4.

Powered by Jotform SignClear
5. In the event of an emergency or a situation that is reasonably considered to be an emergency, the Parent(s)/Guardians(s) authorize Parish or Diocese to seek and authorize emergency medical care to be given to Participant (for example, first aid, medication, anesthesia) and to transport Participant to the nearest hospital for emergency medical or surgical treatment. Parish or Diocese will make reasonable attempts to notify Parent(s)/Guardian(s) or Emergency Contact (if Parent(s)/Guardian(s) are not available) prior to authorizing any such emergency care. Parent(s)/Guardian(s) will be contacted as soon as possible and will be advised prior to any further non-emergency treatment. If Participant does not have insurance, cash payment in full for the necessary medical treatment is the responsibility of the Parent(s) /Guardian(s).

6. Parent(s)/Guardian(s) grant permission to St. Luke Catholic Church to use Participant 's photo publicly to promote the Church. Parent(s)/Guardian(s) understand that the images may be used in print publications, online publications, presentations, websites, and social media. Parent(s)/Guardian(s) also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.

7. To the extent permitted by law, Parent(s)/Guardian(s), for themselves and for Participant, release and agree to indemnify and hold harmless the Parish and Diocese from any and all liability, claims, demands, and costs which may arise as a result of Participant’s participation in the Program, or which are, in any way, related to the Program. This paragraph covers loss under any theory of loss (negligence or otherwise) including but not limited to personal injury or property damage. The Parent(s)/Guardian(s) and Participant assume all risk of injury or loss to themselves or their property
Parent/Guardian Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
Additional Parent/Guardian Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date

Parent Involvment

The Teaching of the Catholic Church is that the parents are the primary catechist of their child. For this reason, we believe that it would be impossible to provide Faith Formation without your presence. Below are some volunteer opportunities and we are asking you the parent/guardian to please select at least one way you would like to get involved.
Volunteer Opportunists

CFF CatechistCFF Catechist HelperEKO Core TeamKeysis Core TeamKeysis Retreat ChaperoneSpecial Events Helper

Name of Parent/Guardian submitting this form*
Email Address*
example@example.com
Should be Empty:

St. Luke Faith Formation 2024-2025 Parental Consent, Information, and Release

Emergency Contact

Physician Information

Insurance and Additional Information

Please read and agree to the following: