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Catechesis of the Good Shepherd
Fall PSR 2023/2024: Registration, Emergency, Media Authorization & Enrollment Fee:
The maximum number of form submissions has been reached. This form is currently not available.
REGISTRATION INFORMATION:
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My Family is Registered at St. Clare of Assisi?
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My child(ren) is/are currently enrolled in a religious education program at the following parish? (please list below)
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Child 1 - Full Name
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Child 1 - Grade Entering Fall 2023
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Last grade my child attended religious education was...?
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Child 2 - Full Name (Type NA if not applicable)
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Child 2 - Grade entering Fall 2023 (Type NA if not applicable)
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Last grade my child attended religious education was...? (Type NA if not applicable)
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Child 3 - Full Name (Type NA if not applicable)
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Child 3 - Grade entering Fall 2023 (Type NA if not applicable)
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Last grade my child attended religious education was...? (Type NA if not applicable)
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Child 4 - Full Name (Type NA if not applicable)
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Child 4 - Grade entering Fall 2023 (Type NA if not applicable)
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Last grade my child attended religious education was...? (Type NA if not applicable)
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Please list any additional children below. Include name, previous grade attended, and the grade they are entering in Fall 2023 (type NA if not applicable).
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Emergency Contact Information:
EMERGENCY CONTACT:
First & Last Name:
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Relationship:
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Relationship:
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MEDICAL CARE INFORMATION:
Physician's Name:
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Physician's Phone Number:
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Preferred Hospital:
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I grant permission for the PSR program to provide or arrange for medical treatment and/or transportation to an evacuation site and/or medical facility for my child(ren) during an emergency or disaster.
REQUIRED
YES, please arrange transportation.
NO, please contact the names provided as emergency contacts first.
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I grant permission for my child(ren) to be released to any of the emergency contacts designated above if I am unable to pick them up in an emergency.
REQUIRED
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NO
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MEDIA AUTHORIZATION:
There may be times when St Clare of Assisi wishes to use your child's photo. As the parent, you may choose the appropriate level(s) of authorization.
I grant permission to use my or my child’s image in a photo or video in the St Clare of Assisi Bulletin, Website or Social Media (Flocknote, Facebook, etc.) as long as no name is used to identify my child.
REQUIRED
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NO
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I grant permission to use my or my child’s name with the image or recording in either of the above mentioned communications.
REQUIRED
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NO
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I grant permission to use my or my child's image for Sponsoring Organizations, including but not limited to: Today and Tomorrow Educational Foundation, Roman Catholic Foundation of Eastern MO, etc. as long as no names are used.
REQUIRED
YES
NO
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I grant permission to use my or my child’s name with the image or recording in any of the above mentioned communications.
REQUIRED
YES
NO
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I grant permission to use my or my child’s image in a photo or video in secular media communications including, but not limited to, print, radio, TV and internet (Examples: St. Louis Post-Dispatch, KMOX radio, and KSDK-TV) as long as no names are used.
REQUIRED
YES
NO
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I grant permission to use my or my child’s name with the image or recording in any of the above mentioned communications. .
REQUIRED
YES
NO
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Parent Agreement:
Aware of the dignity of this holy parental call, and with a reverent awe for that responsibility which is mine, I commit myself to be, in word and example, the first and best teacher of my children in the faith. Practically, this means I will:
Understand that the authentic teachings of Jesus as taught by the Catholic Church will be part of my child’s education and formation;
To the best of my ability respect the teachings of the Church and help my children respect the Church and its teachings;
Regularly participate in the Sunday Eucharist with my family, commit to speak frequently with my children about God, include prayer in my daily life and form my children in the faith; (If not Catholic, support my children’s religious instruction in the teachings and the sacramental life of the Catholic church.)
Participate in and cooperate with the Parish School of Religion in programs that enable me as a parent to take an active role in the religious education of my children, including sacramental preparation for Catholic children;
Support the moral and social doctrine of the Catholic Church to ensure consistency between home and school;
Teach my children by word and example to have a love and concern for the needs of others;
Meet my financial responsibilities in supporting the Parish School of Religion;
Practice stewardship in support of the efforts of our Faith and Parish community.
Parent Agreement
REQUIRED
I Agree
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At dismissal, I prefer to exit the parking lot onto Clayton Road...
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Eastbound
Westbound
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Have the following items been completed? Please check each box that applies:
REQUIRED
Registration
Emergency Contact Information
Media Authorization
Parent Agreement
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By typing my name I attest that the previous information provided is correct.
Parent Signature
REQUIRED
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Enrollment Fee (If paying by check, please make the check out to St Clare of Assisi)
REQUIRED
$0.00 – (Select One)
$285.00 – 1 Child
$380.00 – 2 Children
$475.00 – 3 Children
$570.00 – 4 Children
$0.00 – Pay By Check
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Total:
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