RCIC 2nd year 2018-19 English

Full name (first, middle, last) of child returning to RCIC REQUIRED Please fill out this field. Please enter valid data.

What grade will child be enrolled in 2018-19 REQUIRED Please fill out this field. Please enter valid data.

Who will child reside with in 2018-19 Both parents Mother only Father only Other

CONTACT INFORMATION FOR THE PARENT WITH WHOM THE CHILD WILL RESIDE

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Emergency Contact name and information Please enter valid data.

Which Sacrament (s) will your child receive in 2018-19 Baptism First Communion Confirmation

Please make sure you have provided the parish office with copies of the sacramental certificates your child has received. These certificates need to be turned no later than NOVEMBER 16,2018. If your child will be receiving the sacrament of Baptism , you must provide a copy of their birth certificate.

Shrine of St. Padre Pio Catholic Church
PARENT/GUARDIAN PERMISSION AND LIABILITY WAIVER

I grant permission for my child/children to participate in the Catholic Education Program (CEP) at the Shrine of St. Padre Pio Catholic Church. The CEP program will take place under the guidance and direction of parish employees and/or volunteers from the Shrine of St. Padre Pio Catholic Church. I also consent to the use of any videotapes, photographs, slide, audiotapes, or any other visual or audio reproduction with which my child/children may appear. I understand that these materials are being used for the promotion of the Shrine of St. Padre Pio Catholic Church. Such promotional activities extend to the recruitment, fund-raising, advocacy etc.

As parent/legal guardian, I remain legally responsible for any personal action taken by my child/children. I agree on behalf of myself, my child/children, our heirs, successors, and assigns to hold harmless and defend the Shrine of St. Padre Pio Catholic Church, its officers, directors, agents, and the Archdiocese of San Antonio from any liability for illness, injury or death arising for or in connection with my child’s/children’s attending the CEP program. I release the staff, volunteers, etc. from any liability connected with the use of picture or voice recordings as a part of any of the CEP activities, and I agree to compensate the parish, its officers, directors and agents, and the Archdiocese of San Antonio, or representatives associated with the event for reasonable attorney’s fees and expenses arising in connection therewith.

MEDICAL CONSENT AND PERMISSION TO TREAT
In the event of an emergency, I give permission to transport my child/children to a hospital for emergency treatment.
I am giving medical permission and consent to treat. To the best of my knowledge, my child/children is/are in good health, and I assume all responsibility for the health of my child/children.
Please include a photocopy of your Insurance card, front and back.

I Agree Please select this field.

I have read and understood the parent handbook provided online.

I Agree Please select this field.

Please make sure you have signed the Parent Comitment Agreement. Please see Judy Ortiz at the Parish office or contact by email: judy.ortiz@shrineofpadrepio.com to make sure one has been signed for your child

Program fees for 2018-19 1 child $60 2 children $100 3 children $120 4 children 130 Sacrament Fee $35 per child receiving Sacrament Late Fee $10 added if re registering after 10-28-2018

Grand total Please enter valid data.

Please note if you are re-registering more than one child you will need to submit another form. For your convenience you can pay online. If you are paying by check please make it payable to: Shrine of St. Padre Pio and write in memo RCIC fees

Shrine of St.Padre Pio Catholic Church

San Antonio, TX

3843 Bulverde Pkwy

San Antonio, TX 78259

Office Hours 8:00 am-3:30 pm.

RCIC 2nd year 2018-19 English

Returning Questionaire RCIC 2018-19