Faith Formation Registration Form

– Step 1 of 13

Primary Parent/Guardian Name *

First

Last

Primary Phone (This number will receive group text messages for class reminders and weather alerts.)

Email *

Parent/Guardian Name

First

Last

Phone

Secondary Phone Reminders/Messages

I would like this phone number to also receive class reminders and messages.

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Address *

Address Line 1

Address Line 2

City

State

Zip Code

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Medical Information

This section is required by the Diocese of Springfield Cape Giradeau for all Minor Participants in attendence in Faith Formation Classes across the diocese. In the event of a medical emergency this information will be provided to medical emergency personal and/or hospital staff.

Physician/Clinic Information: Answer the following question: *

My children have the same physician.
Some of my children have a different provider.
My children do not have one individual physician, but all my children use one clinic.
My children do not have a physician/clinic.

Clinic/Physician’s Name: *

Clinic/Physician Phone: *

Health Insurance Carrier: *

Other Insurance Carrier: *

Policy Number *

Parental/Guardian Medical Treatment Autorization:

In the event of an emergency, I hereby give permission to transport my child/children to a hospital for treatment by the hospital medical staff or a doctor. I wish to be advised prior to any further treatment by the hospital or doctor. I further give my permission for health officials to release medical information on my child/children to the diocesan, school, parish, catechetical leader, or parish group leader, if applicable.

Parental/Guardian Medical Treatment Acknowledgement: *

I agree to all the terms and conditions above and below.

By checking this box you agree that you have read the Parental/Guardian Medical Treatment paragraph and agree to and fully understand that this Medical Treatment Authorization will cover your child/children included on this registration form.

Signature *

Clear Signature

Date / Time *

Date

Time

Administration of Medication:

The following choices apply in emergency situations only. No teacher at Sacred Heart Catholic Church during normal Faith Formation class hours will be permitted to admister medication.

Parental/Guardian Administration of Medication *

No medication of any type, whether prescription or non-prescription, may be administered to my child unless the situation is life-threatening and emergency treatment is required.
I herby grant permission for non-prescription medicine (such as Benadryl, Tylenol, throat lozenges, cough syrup) to be given to my child, if deemed advisable.

Signature *

Clear Signature

Date / Time *

Date

Time

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Number of Children (under 18) Registering for Classes

Selected Value: 0

This is the number of children you will be registering. We have classes for grades K-12.

Child #1

Child 1: Name *

First

Last

Date of Birth *

Grade Level (in September) *

Clinic/Physician: *

Clinic/Physician Phone: *

Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

List Medication, Dosage, and Frequency (number of times per day/week, etc): *

List Medication, Dosage, and Frequency (number of times per day/week, etc):

Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Describe medically prescribed diet: *

Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc.) *

My child does NOT have a medical condition
My child DOES have a medical condition

Describe the medical condition(s) we should be aware of: *

Child #2

Child 2: Name *

First

Last

Child 2: Date of Birth *

Child 2: Grade Level (in September) *

Child 2: Clinic/Physician: *

Child 2: Clinic/Physician Phone: *

Child 2: Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Child 2: Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

Child 2: List Medication(s), Dosage, and Frequency (number of times per day/week, etc): *

Child 2: Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

Child 2: List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Child 2: Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Child 2: Describe medically prescribed diet: *

Child 2: Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

Child 2: List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Child 2: Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc.) *

My child does NOT have a medical condition
My child DOES have a medical condition

Child 2: Describe the medical condition(s) we should be aware of: *

Child #3

Child 3: Name *

First

Last

Date of Birth *

Grade Level (in September) *

Clinic/Physician: *

Clinic/Physician Phone: *

Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

List Medication, Dosage, and Frequency (number of times per day/week, etc): *

List Medication, Dosage, and Frequency (number of times per day/week, etc):

Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Describe medically prescribed diet: *

Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc.) *

My child does NOT have a medical condition
My child DOES have a medical condition

Describe the medical condition(s) we should be aware of: *

Child #4

Child 4: Name *

First

Last

Date of Birth *

Grade Level (in September) *

Clinic/Physician: *

Clinic/Physician Phone: *

Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

List Medication, Dosage, and Frequency (number of times per day/week, etc): *

List Medication, Dosage, and Frequency (number of times per day/week, etc):

Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Describe medically prescribed diet: *

Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc.) *

My child does NOT have a medical condition
My child DOES have a medical condition

Describe the medical condition(s) we should be aware of: *

Child #5

Child 5: Name *

First

Last

Date of Birth *

Grade Level (in September) *

Clinic/Physician: *

Clinic/Physician Phone: *

Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

List Medication, Dosage, and Frequency (number of times per day/week, etc): *

List Medication, Dosage, and Frequency (number of times per day/week, etc):

Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Describe medically prescribed diet: *

Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc.) *

My child does NOT have a medical condition
My child DOES have a medical condition

Describe the medical condition(s) we should be aware of: *

Child #6

Child 6: Name *

First

Last

Date of Birth *

Grade Level (in September) *

Clinic/Physician: *

Clinic/Physician Phone: *

Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

List Medication, Dosage, and Frequency (number of times per day/week, etc): *

List Medication, Dosage, and Frequency (number of times per day/week, etc):

Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Describe medically prescribed diet: *

Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc.) *

My child does NOT have a medical condition
My child DOES have a medical condition

Describe the medical condition(s) we should be aware of: *

Child #7

Child 7: Name *

First

Last

Date of Birth *

Grade Level (in September) *

Clinic/Physician: *

Clinic/Physician Phone: *

Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

List Medication, Dosage, and Frequency (number of times per day/week, etc): *

List Medication, Dosage, and Frequency (number of times per day/week, etc):

Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Describe medically prescribed diet: *

Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc.) *

My child does NOT have a medical condition
My child DOES have a medical condition

Describe the medical condition(s) we should be aware of: *

Child #8

Child 8: Name *

First

Last

Date of Birth *

Grade Level (in September) *

Clinic/Physician: *

Clinic/Physician Phone: *

Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

List Medication, Dosage, and Frequency (number of times per day/week, etc): *

List Medication, Dosage, and Frequency (number of times per day/week, etc):

Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Describe medically prescribed diet: *

Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc) *

My child does NOT have a medical condition
My child DOES have a medical condition

Describe the medical condition(s) we should be aware of: *

Child #9

Child 9: Name *

First

Last

Date of Birth *

Grade Level (in September) *

Clinic/Physician: *

Clinic/Physician Phone: *

Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

List Medication, Dosage, and Frequency (number of times per day/week, etc): *

List Medication, Dosage, and Frequency (number of times per day/week, etc):

Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Describe medically prescribed diet: *

Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc.) *

My child does NOT have a medical condition
My child DOES have a medical condition

Describe the medical condition(s) we should be aware of: *

Child #10

Child 10: Name *

First

Last

Date of Birth *

Grade Level (in September) *

Clinic/Physician: *

Clinic/Physician Phone: *

Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

List Medication, Dosage, and Frequency (number of times per day/week, etc): *

List Medication, Dosage, and Frequency (number of times per day/week, etc):

Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Describe medically prescribed diet: *

Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc.) *

My child does NOT have a medical condition
My child DOES have a medical condition

Describe the medical condition(s) we should be aware of: *

Child #11

Child 11: Name *

First

Last

Date of Birth *

Grade Level (in September) *

Clinic/Physician: *

Clinic/Physician Phone: *

Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

List Medication, Dosage, and Frequency (number of times per day/week, etc): *

List Medication, Dosage, and Frequency (number of times per day/week, etc):

Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Describe medically prescribed diet: *

Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc.) *

My child does NOT have a medical condition
My child DOES have a medical condition

Describe the medical condition(s) we should be aware of: *

Child #12

Child 12: Name *

First

Last

Date of Birth *

Grade Level (in September) *

Clinic/Physician Phone: *

Clinic/Physician: *

Missouri Medicaid DCN Number: *

Since every individual who has Medicaid has his/her own DCN (policy) number, please enter the child’s personal DCN (policy) number.

Medication *

My Child does NOT take prescribed medication.
My child DOES take prescribed medication.
My child takes over the counter medication.

List Medication, Dosage, and Frequency (number of times per day/week, etc): *

List Medication, Dosage, and Frequency (number of times per day/week, etc):

Allergies *

My child does NOT have any allergies
My child DOES have an allergy/allergies (medicine, food, plant, etc)

List any allergies (medicines, food, plants, etc.) and describe allergic reactions along with treatment needed if an allergen is encountered: *

Medically Prescribed Diet *

My child does NOT have a medically prescribed diet.
My child DOES have a medically prescribed diet.

Describe medically prescribed diet: *

Physical Limitations/Restrictions (including recent surgery, injury, etc) *

My child does NOT have a physical limitation/restriction
My child DOES have a physical limitation/restriction

List any physical limitations we should be aware of (including any recent surgery, injury, etc.), if any: *

Medical Conditions (i.e. asthma, diabetes, ADHD/ADD, seizures, anxiety, depression, speech/developmental delay, etc.) *

My child does NOT have a medical condition
My child DOES have a medical condition

Describe the medical condition(s) we should be aware of: *

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Emergency Contact (Cannot be a parent/guardian listed above): *

First

Last

Relationship to Child *

Phone *

Secondary Emergency Contact (Cannot be a parent/guardian listed above): (optional)

First

Last

Relationship to Child

Phone

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Parent/Guardian Multimedia Release:

I give my permission for photographs/videos to be used for parish, school, and/or diocesan communications and promotional programs. I understand that any photographs/videos will be used only in a legal manner and that at no time will by child be depicted in an unethical manner. No personal identification information, such as name or address, will be posted with photographs/videos. If you do not want photographs/videos of your child taken, please contact your diocesan or parish catechetical leader.

Parent/Guardian Media Consent and Release Acknowledgement: *

I agree to the above statement and give my consent for my child/children to be photographed/recorded and for photographs/videos to be used for parish, school, and/or diocean communication/promotional programs.
I have restrictions/limits/preferences regarding multimedia release for my child/children.

By checking this box you agree that you have read the Parental/Guardian Multimedia Release section above and agree to and fully understand that your child/children included on this registration form may be photographed/recorded.

Restrictions/Preferences for photo/video consent:

I do not consent to my child/children being photographed or recorded.
I do not wish my child(ren)’s photograph to be used on the church/diocese’s website or social media.
I do not agree to the above conditions and guidelines above.

Signature *

Clear Signature

Date / Time *

Date

Time

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Parental/Guardian Consent:

I, the parent/guardian of the above named participant(s), grant permission for my child/children to participate in Sacred Heart Catholic Church Faith Formation Program which is held weekly on Sundays from September 2026 through May 2027 held on parish grounds at Sacred Heart Catholic Church in Bolivar, MO. This activity will take place under the guidance and direction of parish and/or diocesan employees and/or volunteers. As a parent/guardian, I remain legally responsible for any personal actions taken by the above-named minor(s) participant(s).

Parental/Guardian Consent Acknowledgement: *

I warrant that the information herein (on this form) is correct to the best of my knowledge.

By checking this box you agree that you have read the Parental/Guardian Consent paragraph and agree to and fully understand that your child/children included on this registration form must abide by all rules governing conduct and safety while attending Sacred Heart’s Parish School of Religion (PSR) and that you agree to the terms in the Parental/Guardian Consent section.

Parental/Guardian Liability Waiver:

I the parent/guardian, on behalf of myself, my child/children named herein, and my child/children’s heirs, successors, and assigns, to hold harmless and defend Sacred Heart Catholic Church, parish, school, and/or the Diocese of Springfield Cape-Girardeau, their officers, directors, employees, volunteers, agents, chaperones, and representatives associated with the event, from any claim arising from or in connection with my child attending the event, from any claim arising from or in connection with any illness or injury (including death) or in connection with the cost of medical treatment as a result of an illness or injury. I agree to compensate the parish or Diocese, their officers, directors, employees, agents, and chaperones or representatives associated with the event for reasonable attorney’s fees and expenses that they may incur in any action brought against them as a result of such injury or damage, unless such a claim arises from the negligence of the parish or Diocese.

Parental/Guardian Liability and Waiver Acknowledgement *

I fully understand and sign this Parental/Guardian Consent Form and Liability Waiver knowingly, freely, and willingly.

Parent Name *

First

Last

Signature *

Clear Signature

Date / Time

Date

Time

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Parental/Guardian Abiding by Rules/Regulations Consent:

As the parent/guardian, I remain legally responsible for any personal actions taken by the above-named minor(s) participant(s). My child/children will cooperate fully with any chaperones, drivers, teachers, classroom voluneers, or leaders of this event and obey local laws and ordinances. My child/children will not bring, use, or consume any weapons, tobacco products, alcohol, marijuana products, vaping products, or illegal substances. I agree that my child/children shall abide by all the rules and regulations as established by the parish and diocesan staff for this event. I agree that if my child/children fails(fail) to abide by the code of behavior, my child/children may be sent home immediately.

Parental/Guardian Abiding by Rules/Regulations Consent *

I fully understand and sign this Parental/Guardian Consent Form and Liability Waiver knowingly, freely, and willingly.

By checking this box you agree that you have read the Parental/Guardian Abiding by Rules/Regulations Consent paragraph and agree to and fully understand that your child/children included on this registration form must abide by all rules governing conduct and safety while attending Sacred Heart’s Parish School of Religion (PSR) and that you agree to the terms in the Parental/Guardian Abiding by Rules/Regulations Consent Consent section.

Parent Name *

First

Last

Signature *

Clear Signature

Date / Time

Date

Time

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Drop Off/ Pick Up Guidelines:

Dropping Off

All students will be dropped off between 9:05-9:15am. All students under 7th Grade will need to be escorted into the building by a parent/grandparent/guardian/sibling (9th grade or older) and dropped off in their designated classes if the teacher is in the classroom (usually teachers are in the classrooms by 9:10am). DO NOT LEAVE YOUR CHILD UNATTENDED WITHOUT ADULT SUPERVISON. No student should remain unattended in the hallway or in the classroom. The 7th/ 8th grade and high school students may come to class without an adult and may go directly to their designated classrooms after 9:05am. Siblings younger than 9th grade are not permitted to pick up/drop off their younger brothers and sisters.

Picking Up

Students are to be directly picked up from their classrooms at 10:15am by their parents/guardians/designated adult or a designated sibling (9th grade or older). All students should be picked up from Faith Formation Classes no later than 10:20am. Siblings younger than 9th grade are not permitted to pick up/drop off their younger brothers and sisters. The individual must be a designated adult or sibling (9th grade or older) in order to pick up the student. Teachers often have special instructions and/or information about upcoming events that are crucial for the parent(s)/guardian to know and will be able to instruct the parent(s)/guardian/older sibling when he/she picks up the student(s).

Designated Individuals for Pickup of Child(ren): *

Mother/father/guardian listed at beginning of this form are permitted to pickup child
Sibling (high school or older)
Grandparents
Aunt/Uncle
Other
Restricted Names

Check all that apply

List names of siblings permitted to pickup children: *

Siblings must be in 9th grade or older.

List names of grandparents permitted to pickup children: *

List names of aunts/uncles permitted to pickup children: *

Others allowed to pickup my children: *

Restricted Names: List anyone who is NOT permitted to pickup your child/children: *

Parental/Guardian Drop Off/Pickup Acknowledgement: *

I agree to all the terms and conditions above and below.

By checking this box you agree that you have read the Drop Off/Pick Up Guidelines and agree to and fully understand that your child/children must abide by the Drop Off/ Pick Up Guidelines while attending Sacred Heart’s Parish School of Religion (PSR) Faith Formation Classes.

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Inclement Weather Guidelines:

We generally follow the Bolivar School closings when making decisions regarding snow days. However weather often comes unexpectedly on Saturday/Sunday, so we will base our decisions on current weather that has either caused or may cause imminent danger and would affect driving conditions before/during Faith Formation Classes. In this case, you will be notified by our notification system via group text message. If classes have not been canceled, and you cannot attend, please send a message to the Faith Formation Coordinator: Darlene Arendt @ 417-298-6237.

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Mass Attendance:

We know that the Precepts of the Church state that students and their families to are to attend Mass every weekend and on all Holy Days of Obligation. Far more than a mere obligation, participation in Mass each week provides the graces needed to live family life joyfully and authentically and lays the foundation for lifelong discipleship. Sacred Heart’s Family Faith Formation Program needs these bedrock foundations and so attendance at Mass is expected and is an integral part of our program at all grade levels. A family’s commitment to Christ as expressed through consistent presence at Mass, is the most vital piece needed to foster the seeds of faith in children while also building the Domestic Church within your family.

Mass Attendance Acknowledgement: *

I have read and understand the importance of bringing my family to Mass for Weekend Mass and Holy Days.

By checking this box you acknowledge you have read and agree to attending weekend Mass and Holy Days.

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Little Way Store:

Your child can earn tickets for the Little Way Store (schedule to be given at the parent/teacher meeting). Tickets can be earned through class attendence, memorizing traditional Catholic prayers, Catholic doctrine (i.e. Corporal Works of Mercy, etc), and memorizing Bible Verses. Parents are asked to encourage their child(ren) to memorize and complete their lessons weekly in order to be able to receive tickets for the Little Way Store.

Little Way Store Incentive Program Acknowledgement: *

I have read and agree to help my child through encouragement, attendance, and with memorizing in order to help them earn tickets to spend at the Little Way Store.

By checking this box you acknowledge you have read and agree to help your child with the Incentive Program.

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