» CFF Parental Form1

Parental Acknowlegment and Consent

Each family (parent or guardian) is required to complete and submit this form for the child(ren) enrolled in the Saint Francis of Assisi Children’s Faith Formation Program.

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"*" indicates required fields

Parents / Guardian Information

Name*

First Last

Relationship*

Mother

Father

Guardian

Other

Mobile #*

Cell Phone

Language preference

English

Spanish

Other

Please list the full names of all the chidren registered in the Faith Formation / Religious Education Program (please separate name by commas)*

Email*

Enter Email Confirm Email

Faith Formation uses email and text messages as a primary means to communicate with the parents and guardians. It is imperative that any changes in mobile phone numbers or email be provided to the Parish.

Residence / Address*

Street Address City State ZIP Code

Home mailing address

Date

MM slash DD slash YYYY

St. Francis of Assisi Faith Formation Program: Parental Consents and Permissions

These acknowledgements apply to all children registered with this parent, family and/or guardian(s).

Parent Handbook*

I have read the Parent's Handbook

By signing this page, I acknowledge I have read in its entirety, the Faith Formation / Religious Education Parent Handbook. I further acknowledge that I understand and agree to follow the policies set forth in this handbook, and that I understand what is expected of me as a parent/guardian.

Permission to Participate*

Yes

Permission for my child(ren) to use all the play equipment and participate in all the activities of the parish.

Non-Discrimination*

I agree to the Non-Doscrimination policy.

The registration policy of Saint Francis of Assisi Parish Religious Education does not discriminate based on a child's race, color, religion, sex, national or ethnic origin. By checking this block I acknowledge this policy and agree to support and uphold it in my family’s behavior.

Video and Photography Release*

Yes, permission given

The Office of Catholic Schools of the Diocese of Arlington (OCS) and any of its schools of religion and faith formation may produce or participate in videotape, audio recording, Internet (i.e., Website) or still photograph productions that may involve the use of students' names, likenesses, or voices. Such productions may be used for educational and/or school and/or parish marketing purposes and may be copied or copyrighted with the parish retaining any and all rights to such productions. You have the right to object to the use of your child's name, picture, or voice in these productions and may do so by indicating “No”.

Limited Power of Attorney for Emergency Medical Care Authorization*

Yes, limited power of attorney given for emergency medical care as outlined below

No, limited power of attorney withheld

I hereby give my permission for my child(ren) enrolled in Faith Formation to be given emergency treatment to include first aid and/or CPR by a trained and qualified staff member or the local rescue unit. I further authorize and consent to medical, surgical, and hospital care, treatment, and procedures to be performed for my child(ren) by a licensed physician or hospital when deemed immediately necessary or advisable to safeguard my child's health in the event I cannot be contacted. I waive my right of informed consent to such treatment should an accident and/or illness require immediate medical attention. I acknowledge it is my responsibility to keep this medical emergency information and all other information concerning my child(ren) current throughout my child's enrollment in the Religious Education/Faith Formation program. I authorize the sharing of necessary information included in this document with staff that need to know how to provide a safe and healthy environment for my child(ren). I accept all financial responsibility for any and all care/services rendered and indemnify Saint Francis of Assisi Parish therefore. Further, I released Saint Francis of Assisi Parish from any and all liability arising out of any act or omission hereunder.

Safe Enviroment Formation*

Yes - permission given

No - we elect to opt out

The United States Conference of Catholic Bishops' Charter for the Protection of Children and Youth and the safe-environment policies of the Diocese of Arlington require that all children in our schools and religious education programs be given safe-environment training that is age-appropriate and in accord with Catholic moral principles. The Diocese of Arlington provides such training through the curriculum entitled Formation in Christian Chastity (for children in Grades 1-8) and through a video entitled You Matter (for children in Grades 9-12). Both of the safe environment programs for children are available on the diocesan webpage at: http://www.arlingtondiocese.orq/childprotection/opcyp

Administrative Notes

Please note that the registration is not considered finalized and accepted until fees have been paid

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Phone

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