Religious Education

Friends of Jesus
- It's That Time Again!
  
  It's time to register your children for Religious Education! This includes all Sacramental Classes for First Communion and Confirmation!
  If you would like to be an RE catechist, please contact Augusta Happ at the church office at 970-731-5744 or email at [email protected].
RE Online Registration
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
  Student Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  School Year REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Adopted Yes No
  
  Gender Male Female
  
  Medical Information Consent
  
  MEDICAL MATTERS: I hereby warrant that to the best of my knowledge; my child is in good health, and I assume all responsibility for the health of my child. (Of the following statements pertaining to medical matters, mark those that are applicable.)
  
  EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment.
  
  Family Doctor Please enter valid data.
  
  Family Doctor's Phone Number Please enter valid data.
  
  Family Health Plan Carrier Please enter valid data.
  
  Policy Number Please enter valid data.
  
  Are you Enrolling in a Sacrament?
  
  Which Sacrament Class? REQUIRED Please fill out this field.
  
  Date of Baptism Please enter valid data.
  
  Name of Baptism Church Please enter valid data.
  
  Address of Baptism Church Please enter valid data.
  
  Date of 1st Confession Please enter valid data.
  
  Date of 1st Communion Please enter valid data.
  
  Please email copies of any Sacrament Certificates to Augusta Happ the RE director at [email protected].
  
  Parent Information (Primary)
  
  Role
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email Please enter an email address.
  
  Parent Information (Secondary)
  
  Role
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email Please enter an email address.
  
  Emergency Contact
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Parent/Guardian Consent Form
  
  Medical Information
  
  To the best of my knowledge, my child is in overall good health, and has my/our permission to participate in Immaculate Heart of Mary/Pope John Paul II Catholic Religious Education. In the event of circumstances which indicate that my child is in need of medical care, I/we authorize Church officials to consent to any necessary X-ray examination, medical or surgical diagnosis or treatment, and other evaluation, diagnosis, treatment, medication or hospital care in accordance with standard medical practice by licensed medical personnel. I/we release and agree to hold IHM/JPII parish, parish employees, and volunteers and /or Diocese of Pueblo harmless from any claims due to illness suffered by my child in the course of receiving such medical responsibilty and consequences that may arise as the result of this treatment.
  
  Medical Conditions REQUIRED Please fill out this field. Please enter valid data.
  
  Food Allergies REQUIRED Please fill out this field. Please enter valid data.
  
  Disabilities REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian eSignature: By marking this box I authorize the above information. REQUIRED Yes Please fill out this field.
  
  Parish Waiver and Release
  
  I/we agree and grant permission for my/our child, to participate in the IHM/JPII Religious Education classes, programs and events. I understand that this activity will take place under the guidance and direction of parish volunteers and/or parish employees. I agree on behalf of myself, my child's other parent or guardian, my child named herein, or our heirs, successors, and assignees, to release, waive, indemnify and hold harmless and defend the Diocese of Pueblo, the IHM/JPII Catholic Parish, and their employees, affiliates, officers, agents, volunteers, directors, and representatives, of any personal unjury or property damage claims suffered as a result of the voluntary participation in the activities described above, including any transportation within, to, or from Pagosa Springs, Colorado. This release includes damages or injuries by the negligence (active or passive) or any of the entities or individuals named or described in this release. This waiver and release is intended to release and discharge in advance the promoters, sponsors, officials, leaders, the Diocese of Pueblo, the Bishop of Pueblo, a Corporation Sole, and IHM/JPII Catholic Parish, and thier affiliates, officers, agents, volunteers, and employees from all liability arising out of or connected in any way with my participation in the activity.
  
  Parent/Guardian eSignature: By marking this box I authorize the above information. REQUIRED Yes Please fill out this field.
  
  Photo Consent
  
  Unless other written instruction is submitted, I also consent to allowing my child's image to be recorded, either by photograph or video and used during the Religious Education program for future advertisement of Parish Religious Education Programs. Any other use will require further consent.
  
  Photo Consent Yes No
  
  Re Registration40.0
  
  Total:
  
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