Religious Education Forms – Saint Rose of Lima Catholic Church

RELIGIOUS EDUACATION REGISTRATION
2020-2021

(PLEASE PRINT CLEARLY - FAVOR DE USAR LETRA DE MOLDE)

FAMILY NAME

Apellido de Familia

DATE/ FECHA

Home Address - Domicilio

City - Ciudad

Zip - Código

Phone

Phone - Teléfono

Mailing Address (if different from above)

E-MAIL ADDRESS

Correo Electrónico

CELL PHONE:

Celular

STUDENT LIVES WITH (Estudiante vive con):

Both Parents
Mother
Father
Other

**REGULAR MASS ATTENDANCE / OR VIRTUAL IS CENTRAL TO PREPARING CHILDREN FOR FIRST COMMUNION .

WHAT MASS DO YOU USUALLY ATTEND?

ASISTIENDO MISA REGULARMENTE ES CENTRAL EN LA PREPARACIÓN DE LA PRIMERA COMUNIÓN . ¿A QUÉ MISA ACOSTUMBRA ASISTIR SU FAMILIA?

1) NAME/NOMBRE

Age/Edad

Birth Date

School / Escuela

Grade/Grado

Email Address:

SACRAMENT REC’D:

Baptism Date /Fecha de Bautismo

Church/Iglesia

2) NAME/NOMBRE (copy)

Age/Edad

Birth Date

School / Escuela

Grade/Grado

Email Address:

*If Child is over the age of 7 and has not been Baptized, he/she would be required to enroll RCIA for Children and provide a copy of Birth Certificate. Parents must schedule an appointment with Religious Ed Coordinator.

PLEASE COMPLETE MEDICAL/EMERGENCY INFORMATION
POR FAVOR COMPLETE INFORMACIÓN MÉDICA Y DE EMERGENCIA

FAMILY MEDICAL/EMERGENCY INFORMATION

FAMILY NAME (APELLIDO)

PARENTS NAME(S)

NOMBRE DE LOS PADRES

PHONE/TELÉFONO #

Doctor

Phone

Office Address

EMERGENCY RELEASE INFORMATION (Contactos de emergencia): (Adults only - solamente adultos) *** Student will only be released to those listed below. *** Any changes MUST be in writing.

Phone

1. (copy)

Phone (copy)

1. (copy) (copy)

Phone (copy) (copy)

MEDICAL CONDITIONS WE SHOULD KNOW ABOUT: (MUST COMPLETE FOR EACH STUDENT)

CONDICIONES MEDICAS QUE DEBERÍAMOS DE SABER: (DEBE COMPLETAR PARA CADA ESTUDIANTE)

NAME

Condition

Allergies / Alergias

Medications / Medicamentos

In Special Education Classes?

NAME

Condition

Allergies / Alergias

Medications / Medicamentos

In Special Education Classes?

MEDICAL INSURANCE CARRIER:

SUBSCRIBER:

GROUPNUMBER/PLAN

I hereby authorize St. Rose of Lima Religious Education staff to seek and obtain medical care in the event of an emergency for all of the registered students in our family. Parents are responsible for any medical costs incurred, including ambulance costs. I also verify that medical insurance information given above covers all students from my family registered.

Por la presente autorizo al personal de Educación Religiosa de Sta. Rosa de Lima a buscar y obtener atención médica en caso de una emergencia para todos los estudiantes registrados en nuestra familia. Los padres son responsables de cualquier costo médico incurrido, incluyendo los costos de ambulancia. También verifico que la información del seguro médico dada arriba cubre a todos los estudiantes de mi familia registrados.

PARENT SIGNATURE:

DATE

PLEASE PROVIDE A COPY OF YOUR CHILD’S BAPTISM AND FIRST COMMUNION CERTIFICATES WITH YOUR REGISTRATION.

FAVOR DE PROVEER UNA COPIA DE LOS CERTIFICADOS DE BAUTISMO DE SU HIJO(A) CON SU REGISTRO. Gracias.

RELIGIOUS EDUACATION REGISTRATION 2020-2021

PLEASE COMPLETE MEDICAL/EMERGENCY INFORMATION POR FAVOR COMPLETE INFORMACIÓN MÉDICA Y DE EMERGENCIA

FAMILY MEDICAL/EMERGENCY INFORMATION

RELIGIOUS EDUACATION REGISTRATION
2020-2021

PLEASE COMPLETE MEDICAL/EMERGENCY INFORMATION
POR FAVOR COMPLETE INFORMACIÓN MÉDICA Y DE EMERGENCIA