Offi ce of Rel i gi ous Educati on

Rel i gi ous Educati on Regi strati on Form

***Pari sh Regi strati on i s requi red for parti ci pati on i n the Rel i gi ous Educati on
Program. I f you are not regi stered yet, pl ease stop by the rectory offi ce to
obtai n a regi strati on card for the pari sh. ***

**Pl ease pri nt neatl y**

Parti ci pant I nformati on

Participant Name: (Last, First, MI): Current
Grade:
Participant Address:
City: State: Zip Code:
Student Email Address:
Current School Attending:
Student Home Phone: Student Cell Phone:

Is student able to text?: (Please Circle) Yes No
DOB: Month Day Year
Place of Birth:
Previous Religious Education Name & City:




Parental I nformati on

Mothers Name w/ Maiden Name: Fathers Name:
Parent Address:
City: State: Zip Code:
Parent Address (If Different from Above):
City: State: Zip Code:
Mother Cell Phone: Father Cell Phone:
Mother Work Phone: Father Work Phone:
Mother Email:
Father Email:
Marital Status:
_____Married _____Separated _____Divorced _____Single _____Widowed
If divorced or separated, do parents share custody? ________ Yes _______No
If NO, then who has custody?

Are there any other Court Orders or is there any other information we need to know to keep your child safe? ____Yes ____No
If YES please attach a written explanation.


Saint Michael Parish with Mission of Saints Peter & Paul
Sacramental I nformati on
Bapti sm Reconci l i ati on Euchari st Confi rmati on
Date/ Church: Date/ Church: Date/ Church: Date/ Church:
My chi l d i s enrol l i ng i n the sacrament of:
_____ Bapti sm _____ Reconci l i ati on _____ Euchari st _____ Confi rmati on I _____ Confi rmati on I I

Safe Envi ronment Pol i ci es

Parents, by signing below you affirm that you have read or received a copy of our Safe Environment
Statement and agree to its terms, conditions, users, and requirements.

Parent Si gnature: _________________________________________ Date: _____________

Medi cal Matters: I hereby warrant that to the best of my knowledge, my child is in good health
and I assume all responsibility for the health of my child. (Of the following statements pertaining to
medical matters, sign only those that are applicable.)

Emergency Medi cal Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for
emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event
of an emergency, if you are unable to reach me at the above numbers, contact:
Name of Emergency Contact Person Relationship to Student Phone
Family Doctor/Office Phone
Health Insurance Provider Policy Number
Parent Signature Date
Emergency Medi cal Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for
emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event
of an emergency, if you are unable to reach me at the above numbers, contact:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Parent Signature Date
Speci fi c Medi cal I nformati on: The parish will take reasonable care to see that the following information will be held in
confidence.
Allergic Reactions (medications, foods, plants, insects, ect):
Immunizations: Date of last tetanus/diphtheria immunization:
Does child have any physical limitations?
Does child have a medically prescribed diet?
Is child subject to chronic homesickness, emotional reactions to new situations, sleepwalking, bedwetting, fainting?
Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chicken pox, etc.? If so, list date
and disease or condition:
You should be aware of these special medical conditions of my child:


Photography Rel ease Wai ver
I hereby authorize St. Michael Parish, consisting of St. Michael Church, Waialua and the Mission of
Sts. Peter and Paul, Waimea, its agents and employees to make, distribute, exhibit, reproduce and
otherwise use my name and photographic likeness in matters related to church business. This
includes, but is not limited to, news releases, such as to The North Shore News, and websites, such
as stsmichaelpeterpaul.com.
I hereby waive all rights or claims including, but not limited to, claims for invasion of the right of
privacy, invasion of the right of publicity, and any type of defamation.
I hereby waive all rights of inspection or approval and I irrevocably release St. Michael Parish,
consisting of St. Michael Church, Waialua and the Mission of Sts. Peter and Paul, Waimea, its
agents and employees, and all other the parties whomsoever St. Michael Parish, its agents
and employees may appoint to use my likeness, name, or photograph from any liability
arising out of or in connection with the use of my name, photographic likeness, and
photographic negatives

Parent Signature: _________________________________________________ Date: _________________

Regi strati on Fees:

Per Child $5.00
First Holy Communion Preparation (Certificate,
Lei)
$25.00
Confirmation II Preparation (Certificate, Lei) $25.00

Participation in the religious education program is only one part of your familys responsibility as
members of the St. Vincent de Paul Catholic Church community. At Baptism you, as parents or
godparents, promised to bring your child up in the Catholic faith; that means teaching him/her how
to pray, how to worship, and how to serve others.
Pl ease compl ete i f prepari ng for Fi rst Hol y Communi on or Confi rmati on
Participant Last Name:

Participant First Name:

Participant Middle Name:

Birth Place City:

Birth Place State: Date of Birth: Age:
Church of Baptism: City/State of Baptism: Date of Baptism:
Current Address:

City: State: Zip Code:

Fathers Full Name:

Mothers Full Name (including Maiden)

Please Attach a Copy of Baptismal Record & Birth Certificate










Weekl y Sunday Schedul e

St. Mi chael Pari sh
PreK, K5, 1
st
, 2nd, 3rd, 4th, 5th, 6th, 7th, and 8
th
08:30am 09:45 am
Confirmation I and II 08:00am 09:45am

Mi ssi on of Sts. Peter and Paul
PreK, K5, 1
st
, 2nd, 3rd, 4th, 5th, 6th, 7th, and 8
th
08:30am 09:20 am

We encourage students to attend at l east one weekl y mass. Mass ti mes l i sted bel ow.

St. Mi chael Pari sh
Saturday Mass 05:00 pm
Sunday Masses 07:00 am
10:00 am

Mi ssi on of Sts. Peter and Paul
Sunday Masses: 07:30 am
09:30 am