RE Student Information Form

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Religious Education Program

St. Philip the Apostle Religious Education Program Student Information Form

* Indicates required field

Family Last Name *

Are any children new to the RE Program? *

Yes No

Name of child(ren) new to the program *

Please fill out an information card about each new student. The completed card and a copy of the child's baptismal certificate may be emailed to bnicolai@st-phil.org or faxed to 630-543-4672.

Will any children be in home study rather than regular classes? *

Yes No

Name of child(ren) in homestudy *

Last, First Name of Child #1 *

Sex of Child #1 *

Male Female

Birthdate of Child #1 *

MM/DD/YY

Grade of Child #1 *

Last, First Name of Child #2 *

Sex of Child #2 *

Male Female

Birthdate of Child #2 *

MM/DD/YY

Grade of Child #2 *

Last, First Name of Child #3 *

Sex of Child #3 *

Male Female

Birthdate of Child #3 *

MM/DD/YY

Grade of Child #3 *

Last, First Name of Child #4 *

Sex of Child #4 *

Male Female

Birthdate of Child #4 *

MM/DD/YY

Grade of Child #4 *

This form updates my original medical permission form for the above child(ren) who are registered in the RE Program to receive emergency treatment if I cannot be contacted while they are attending religious education classes at St. Philip the Apostle Parish. I agree to the terms of the original statement.

Electronic Signature *

Date *

Please list child(ren)'s names below and any medical issues, allergies, or learning disabilities that may impact on their religious education experience.

Name of Child "A" *

Medical/allergy issues or learning disabilities of Child "A" *

Name of Child "B" *

Medical/allergy issues or learning disabilities of Child "B" *

Pictures/videos of the religious education students may be taken during the school year for publicity or information purposes to advertise events in the parish. The pictures may be posted on the parish website, the parish bulletin boards, in parish publications and/or newspapers (local or diocesan). Your child(ren)'s names will not be linked to the photos.

Picture/Video Permission *

Yes, I give permission for videos/pictures. No, I do not give permission for videos/pictures.

Parents are encouraged to read the following publications:
Diocesan Pastoral Policy Regarding Sexual Abuse of Minors
Parent Guide to Preventing Child Sexual Abuse

Diocesan Pastoral Policies *

I was given a paper copy of these policies the first time I registered my child(ren). I read the pastoral policies on-line.

After you click "submit" for this page, please return to the on-line registration home page to complete the payment process.

Submit

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St. Philip the Apostle Catholic Parish
1223 W. Holtz Avenue in Addison, IL 60101
Phone #: 630-628-0900