SEAS-Ontario OCIC Application

RELIGIOUS EDUCATION REGISTRATION
ORDER OF CHRISTIAN INITIATION FOR CHILDREN (OCIC)

SEASCC PARISH 2713 S. Grove Avenue Ontario, CA / 909-947-2956

FAMILY LAST NAME:

PRIMARY EMAIL

example@example.com

PRIMARY PHONE #

Format: (000) 000-0000.

ADDRESS

Street Address

Street Address Line 2

CITY/STATE

Street Address

Street Address Line 2

City

Postal / Zip Code

FATHER FULL NAME:

First NameLast Name

EMAIL:

example@example.com

CELL #:

Format: (000) 000-0000.

RELIGION:

If you are catholic, please indicate the sacraments the father has received:

MOTHER FULL NAME:

First NameLast Name

EMAIL:

example@example.com

CELL #:

Format: (000) 000-0000.

RELIGION:

If you are catholic, please indicate the sacraments the mother has received:

Name

First NameLast Name

Date of Birth

Date

School Grade

Gender

Was in religion class last year?

Has the student been baptized?

Name

First NameLast Name

Date of Birth

Date

School Grade

Gender

Was in religion class last year?

Has the student been baptized?

Name

First NameLast Name

Date of Birth

Date

School Grade

Gender

Was in religion class last year?

Has the student been baptized?

Name

First NameLast Name

Date of Birth

Date

School Grade

Gender

Was in religion class last year?

Has the student been baptized?

Name

First NameLast Name

Date of Birth

Date

School Grade

Gender

Was in religion class last year?

Has the student been baptized?

Is your family registered as members of Saint Elizabeth Ann Seton?

Envelope #

Child(ren) live with:

Do any of your children have medical concerns or food allergies? Please list: IF NOT, MUST WRITE "NONE"

Do any of your children have special learning needs/disabilities? Please list: IF NOT, MUST WRITE "NONE"

In the event of an emergency, I authorize the staff of Saint Elizabeth Ann Seton Parish and/or the nearest medical facility to administer immediate medical attention to my child(ren) if necessary and only if unable to contact me. Signed:

Parent/Legal Guardian Signature

Name Printed

Date Signed

Date

In the event that I am unable to pick up my child(ren) from Faith Formation, the following people have my permission to do so:

NAME:

PHONE:

NAME:

PHONE:

The success of our programs relies on the generosity of our volunteers. Please check the boxes to indicate your interest and availability to help out.

I am available to lend a helping hand...

Name

First NameLast Name

Child's Name

First NameLast Name

By my signature below, I grant permission for my child(ren) to participate in St. Elizabeth Ann Seton Religious Education Program under the guidance and direction of parish staff and/or volunteers. As parent/guardian, I remain legally responsible for any personal actions taken by the above-named minor(s).

By my signature below, I grant permission for my child/ren, to participate in Saint Elizabeth Ann Seton Faith Formation under the guidance and direction of parish employees and/or volunteers from Saint Elizabeth Ann Seton Parish. As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor(s). I agree on behalf of myself, my child/ren named herein, or our heirs, successors, and assigns, to hold harmless and defend Saint Elizabeth Ann Seton Parish, its officers, directors, employees and agents, and the Diocese of San Bernardino, its employees and agents, chaperones, or representatives associated with SEAS, from any claim arising from or in connection with my child/children/teen(s) attending programming or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith.

Parent/Legal Guardian Signature

Name Printed

Date Signed

Date

PRIMARY CONTACT INFORMATION

REGISTERING STUDENTS

Student 1

Student 2

Student 3

Student 4

Student 5

MEDICAL RELEASE AUTHORIZATION

STUDENT PICK-UP AUTHORIZATION

VOLUNTEERS NEEDED

Social Media/Online Zoom/Photo/Video Permission and Medical Release Authorization