2021-2022 FAMILY Religious Education/Youth Ministry Registration Form Registration FeesRegistration fees are $25 per child - $75 max per family. If you are not a registered member of St. Sebastian you need to add an additional $50 per family to the above. We do not want payment to be an obstacle for attending RE. If there is a financial hardship, please contact the RE office.FAMILY INFORMATIONFamily Last Name* Are you a registered member of St. Sebastian?* Yes No If not, what Parish are you registered at?* Preferred Email* Please provide preferred email(s) at which you wish to receive communication.Alternate Email Please provide preferred email(s) at which you wish to receive communication.Preferred Phone*Alternate Phone*Parent/Guardian Name 1* First Last Religion*Relationship to Child(ren)Religion Parent/Guardian Name 2 First Last *Relationship to Child(ren)Religion Religious Education Children Please list first names of all children you are registering for RELIGIOUS EDUCATION and consenting to join the program. You will be directed to complete additional information for each child.Youth Ministry Children Please list first names of all children you are registering for YOUTH MINISTRY and consenting to join the program. You will be directed to complete additional information for each child.EMERGENCY CONTACT INFORMATIONParents will always be connected first for any emergency. If we are unable to reach you, is there someone else we may contact in an emergency?Emergency Contact Name Relationship to Child(ren) Emergency Contact Phone*Cell Phone FAMILY MEDICAL INFORMATIONFamily Doctor*Only used in case of emergency.Name of DoctorPhone Number HEALTH INSURANCE INFORMATIONOnly used in case of an emergency.List*Name of Insurance CompanyPolicy NumberGroup NumberContract Number Medical Treatment ReleaseAs the parent or legal guardian, I hereby authorize first aide/medical treatment (for all children listed on this form) in the event of an emergency, which may endanger her/his life, cause disfigurement, physical impairment, or undue discomfort if delayed. It is understood that efforts will be made to contact the person listed on this form as soon as reasonably possible. In the event that the aforementioned requires my authorization for treatment and I cannot be reached in an emergency, I hereby give my permission to the physician selected by the activity leader to hospitalize, secure medical treatment, and/or order an injection, anesthesia or surgery for the aforementioned as deemed necessary. I understand all reasonable safety precautions will be taken at all times by the parish and its agents during youth programing and events. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold St. Sebastian Church, its leaders, employees, drivers, volunteers, or the Roman Catholic Diocese of Grand Rapids liable for damages, losses, diseases, or injuries incurred by the aforementioned.Signature*By checking the box you are agreeing to the above Medical Treatment Release Statement for all children listed on this form. I agree with above Photo ConsentPhotos may be taken during class or other events.*Photos are often taken during our program nights and family events. They may appear on our website, in the bulletin, or posted in the parish hall. Clicking the box indicates this is for all children listed on this form. By clicking the box, it indicates this applies to all children listed on this form.I give permission for program faciliators to use my child(ren)'s photograph and name where appropriateI give permission of photo only-NO NAMEI DO NOT give permission under any circumstancesDROP OFF AND PICK UPSignature*By checking this box you understand that 1. You must come in to drop off and pick up your child from their classroom. 2. Your child will not be released to anyone under the age of 18 unless you have cleared it with the director. Signature Drop-Off & Pick-Up Person*Who will be the main person(s) picking up your child? If you will be carpooling, please indicate that also.How Many Children are You Registering?*1-$25.002-$50.003-$75.004-$75.00This includes all children in your family whether they are registering for Religious Education or Youth MinistryAny Additional Information or Comments. Clicking SubmitBy clicking Submit you will be directed to begin registering your individual children. Please choose which program your youngest child will be joining. If you have children in both programs, you will have the opportunity to register for each program later in this process. Religious Education Preschool through 6th Grade Youth Ministry - 7th Grade through 12th Grade
