CCUP Sacramental Preparation 2019-2020
It is important that you register your student by September 20th to give our student catechists a few weeks to prepare. Submit this form and the registration form and the registration fee to Corpus Christi by that Friday at 5 p.m.

The fee for sacramental preparation is $25 for each child.

If you have any questions regarding any of the information in this letter, please do not hesitate to contact Father Jeremy at jmiller@ccup.org. We look forward to working with your students as we grow together in faith.
Medical Form
The law requires that parental permission be obtained for operative and medical procedures on minors. Please fill out the following consent form so that emergency procedures may be promptly carried out. Those in charge will make every effort to notify you if your child is hurt. Also, no operation other than minor surgery will be performed, except in an extreme emergency, without parents being contacted and fully informed.
Child's Name *
First and Last
Your answer
I give my permission for operative and medical procedures as may be deemed necessary for my son or daughter (Parent or Guardian's Signature) *
I understand my typed signature below holds the same weight and binding authority as my handwritten signed signature.
Your answer
Mother’s Day Phone: *
Your answer
Mother’s Evening Phone:
Your answer
Father's Day Phone: *
Your answer
Father's Evening Phone:
Your answer
Is the above covered by hospitalization insurance? *
Is so, what is the name of the company?
Your answer
Policy Number
Your answer
Group Number
Your answer
Individual Number
Your answer
Yes you can give my child the following dose of Tylenol:
Please list facts concerning the child’s medical history, including allergies and medications being taken, and any physical impairments to which a physician should be alerted.
Your answer
Preferred Physician *
Your answer
Physician phone *
Your answer
Physician address *
Your answer
Preferred Dentist *
Your answer
Preferred Dentist phone *
Your answer
Preferred Dentist address *
Your answer
Year of child’s last tetanus shot *
Your answer
Anything else we should know about your child:
Your answer
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