St. Therese of the Child Jesus Catholic Church

Religious Education Registration

Home Address

Primary Phone *
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    Additional Phone
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      Additional Emergency Contact Name *
      Emergency Contact number *
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        I would like to volunteer as a....*
        Catechist
        High School Assistant
        High School Babysitter
        Office help on Saturdays
        Office help on Wednesdays
        None, I am unable to volunteer at this time
        If you are selected as a Catechist or Assistant Catechist, please indicate the grade level you prefer (1,2,etc)
        If we offer childcare while you are attending the parent meetings or during RE hours to allow you to volunteer would you use the services?
        Yes
        No
        Attended Religious Education classes at STOJCC 2024-2025?*
        Yes
        No

        Child #1

        First Name *
        Last Name *
        Gender*
        M
        F
        Birth City *
        Date of Birth *
        State *
        Baptized*
        Y
        N
        Country *
        Grade for 25-26 School year *
        1
        2
        3
        4
        5
        6
        7
        8
        9
        10
        11

        If Baptized...

        What is the date of Baptism?
        Name of the church they were baptized and the city and state it is located in?
        Which sacrament are you needing assistance preparing your child for? (Choose all that apply)
        Baptism
        Communion
        Confirmation
        Please share any special needs your child has to assist us in serving him/her. For example, health, learning, etc.
        Would you like to register another child?
        Yes
        No

        Child #2

        First Name *
        Last Name *
        Gender*
        M
        F
        Birth City *
        Date of Birth *
        State *
        Baptized*
        Y
        N
        Country *
        Grade for 25-26 School year *
        1
        2
        3
        4
        5
        6
        7
        8
        9
        10
        11

        If Baptized...

        What is the date of Baptism?
        Name of the church they were baptized and the city and state it is located in?
        Which sacrament are you needing assistance preparing your child for? (Choose all that apply)
        Baptism
        Communion
        Confirmation
        Please share any special needs your child has to assist us in serving him/her. For example, health, learning, etc.
        Would you like to register another child? *
        Yes
        No

        Child #3

        First Name *
        Last Name *
        Gender*
        M
        F
        Birth City *
        Date of Birth *
        State *
        Baptized*
        Y
        N
        Country *
        Grade for 25-26 School year *
        1
        2
        3
        4
        5
        6
        7
        8
        9
        10
        11

        If Baptized...

        What is the date of Baptism?
        Name of the church they were baptized and the city and state it is located in?
        Which sacrament are you needing assistance preparing your child for? (Choose all that apply)
        Baptism
        Communion
        Confirmation
        Please share any special needs your child has to assist us in serving him/her. For example, health, learning, etc.
        St Therese of Jesus Religious Education Families Commitment*
        Upon my child(ren)'s Baptism, I committed to educate my child(ren) in the Catholic faith. I understand that I am my child(ren)'s first and main teacher on the Catholic Faith. I have received and red the "Commitment of Parents of Religious Education-Program Students" I understand that I have committed myself and my family to be an example to our children of what it means to be a Christian/Catholic and participate in the Church's sacramental life and help with the needs of the Religious Education program throughout the year (time, treasure, or talent).
        Please read the attached form and provide Digital Signature for agreement to the Parent Commitment (Type your full name below) *

        From time to time we take pictures during St Therese of Jesus Religious Education activities. We would like your permission to use these pictures.

        Do you grant permission to use photos of your child by St Therese of Jesus Religious Education program on parish website, Parish Facebook/Instagram page, newsletter, bulletin and in The Observer?*
        Yes
        No

        Emergency Health Information

        As a parent or guardian, I authorize the treatment of my minor child by a qualified physician  for treatment of illness or accidents of a more serious nature.  I understand that I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In case of a medical emergency, I understand that every effort will be made to contact the parents/guardian of the student.  In the event that I cannot be reached, I hereby give permission to the physician selected by the adult staff to hospitalize, secure proper treatment for, and/or injection, anesthesia or surgery, if deemed necessary for my child.  

        Family Doctor *
        What questions or concerns do you have?
        Submit