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Catechesis of the Good Shepherd
Register here to enroll your children ages 3 - 6. CGS will meet in the Parish Atrium.
Mondays from 9:15am to 10:45am.
Katinka Ritz (Head Teacher) katinkaevers@gmail.com
Email address *
STUDENT INFORMATION
Name of Child
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Address, City, State, Zip
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Gender
Date of Birth
MM
/
DD
/
YYYY
Age
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Grade
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School
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Parish of Registration
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FATHER / GUARDIAN INFORMATION
Name
Your answer
Religion
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Phone
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Address
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Marital Status
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Email
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Work Place Address and Contact
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MOTHER / GUARDIAN INFORMATION
Name
Your answer
Religion
Your answer
Phone
Your answer
Address
Your answer
Marital Status
Your answer
Email
Your answer
Work Place Address and Contact
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MEDICAL INFORMATION
Name of Physician / Phone Number
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Medical Insurance Carrier and Policy Number
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Address and Contact of Medical Insurance Provider
Your answer
Allergies
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Known Conditions
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Emergency Contact: Name, Relationship, Address, Phone
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Parent Pickup Release - List all adults for consent
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VOLUNTEER OPPORTUNITIES
Indicate interest in assisting.
STATEMENT OF CONSENT
If you would like your youth to participate in parish activities, please sign and return the following statement of consent and release of liability. As parent or legal guardian, you remain fully responsible for any legal responsibility which may result from any personal actions taken by your youth. In consideration for the opportunity for my child to participate in parish activities, and fully recognizing that such an undertaking involves an element of risk, we assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify and agree to hold harmless the Diocese of Pensacola-Tallahassee and The Cathedral of the Sacred Heart Parish, and their employees, agents, volunteers, and other persons acting on their behalf. Neither the Diocese of Pensacola-Tallahassee, The Cathedral of the Sacred Heart Parish , nor said agents, employees, or volunteers, shall be held financially responsible for any injury, illness or death incurred as a direct or indirect result of this activity. We the undersigned have read this release and understand all its terms and execute it voluntarily and with full knowledge of its significance. EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I/we hereby authorize the Diocese of Pensacola-Tallahassee, and The Cathedral of the Sacred Heart Parish, through its authorized representatives, to transport my child to a hospital or other doctor’s office or medical facility for emergency medical attention. I/We additionally authorize such representatives of the Diocese and/or School to obtain and give consent to whatever medical treatment the representative deems necessary, including the administering of anesthetic and surgery, and do hereby release the Diocese and The Cathedral of the Sacred Heart Parish, and their authorized representatives from any and all claims which may arise from the above-referenced obtaining and consenting to medical treatment. I/We wish to be advised, if possible, prior to the providing of any non-emergency medical treatment by any physician or hospital. Finally, I/we hereby give permission for the Diocese of Pensacola-Tallahassee and any of its affiliated organizations, including, but not limited to The Catholic Compass, to use the name of my child and/or his/her photograph for promotional, news, or public relations purposes in print and/or electronic media.
By signing my name in print below, I accept the terms of the agreement. *
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