2022/2023 Religious Education Class Registration Form Please register by August 31. If you have any further questions, please contact our Religious Education Director, Mrs. Sharon Lechtenberg, at [email protected] or (918) 381-7869.
REGISTRATION POLICIES (EVERYONE WILL RE-REGISTER EACH YEAR)
SCHEDULE OF CLASSES FOR 2022-2023
Both Father & Mother or Guardian(s) First Name(s):
Both Father & Mother or Guardian(s) Last Name(s):
Address (including city and zip code):
Home Phone (please include dashes):
Father's Cell Phone (please include dashes):
Mother's Cell Phone (please include dashes):
Father's Religion:
Mother's Religion:
Preferred Email Address:
School(s):
Student(s) Resides with:
If student’s last name is different from parent’s last name, please indicate:
I am a registered parishioner at St. Bernard’s:
PRESCHOOL (3 & 4 YEAR OLDS) & KINDERGARTEN This form enables you to register up to three (3) students in this age bracket. If you need to register another child in this age bracket, please contact Sharon.
Student First & Last Name:
Age as of September 1, 2022 (or indicate Kindergarten):
Date of Birth:
Sex:
Has this child been Baptized?
Please select which class time you are registering for:
Student First & Last Name:
Age as of September 1, 2022 (or indicate Kindergarten):
Date of Birth:
Sex:
Has this child been Baptized?
Please select which class time you are registering for:
Student First & Last Name:
Age as of September 1, 2022 (or indicate Kindergarten):
Date of Birth:
Sex:
Has this child been Baptized?
Please select which class time you are registering for:
GRADES 1-12 This form enables you to register up to six (6) students in this age bracket. If you need to register another child in this age bracket, please contact Sharon.
Student First & Last Name:
Student's Grade as of Fall, 2022:
Date of Birth:
Sex:
Please select which Sacrament(s) this child has received:
Please select which class time you are registering for:
Student First & Last Name:
Student's Grade as of Fall, 2022:
Date of Birth:
Sex:
Please select which Sacrament(s) this child has received:
Please select which class time you are registering for:
Student First & Last Name:
Student's Grade as of Fall, 2022:
Date of Birth:
Sex:
Please select which Sacrament(s) this child has received:
Please select which class time you are registering for:
Student First & Last Name:
Student's Grade as of Fall, 2022:
Date of Birth:
Sex:
Please select which Sacrament(s) this child has received:
Please select which class time you are registering for:
Student First & Last Name:
Student's Grade as of Fall, 2022:
Date of Birth:
Sex:
Please select which Sacrament(s) this child has received:
Please select which class time you are registering for:
Student First & Last Name:
Student's Grade as of Fall, 2022:
Date of Birth:
Sex:
Please select which Sacrament(s) this child has received:
Please select which class time you are registering for:
Please indicate if your child(ren) has any special needs, learning disabilities, food allergies, or special requests:
I am willing to be one of the following (*RE fees (not Sacramental fees) are waived if a parent volunteers to be a full-time teacher for the program):
Registration Fee: $40 for 1 child in family, $60 for 2 children in family, $70 for 3 or more children in family
Total Fees for Family:
SAINT BERNARD OF CLAIRVAUX PARISH MEDICAL RELEASE FORM I/We the undersigned parent(s) or legal guardian(s) of the child(ren) listed on this registration form do hereby authorize any x-ray examination, anesthetic, dental, medical or surgical diagnosis or treatment by any licensed physician or dentist and/or hospital service that may be rendered to said minor under the general, specific or special request of Father Jack Gleason, Sharon Lechtenberg, Lisa Berry, or any person working on their behalf. This consent will remain effective from August 1, 2022, until October 1, 2023. I understand that every precaution will be taken to ensure my daughter/son/ward’s safety. Should an accident occur, I will not hold St. Bernard’s Parish or the Diocese of Tulsa or its paid staff or volunteer staff responsible.
E-Signature of Parent/Guardian (please type out full name):
Date:
Emergency Phone Numbers (please list First & Last Name, Relationship, and Phone Number)
VIRTUS SELF SAFETY GUIDANCE PROGRAM FOR CHILDREN The Diocese of Tulsa requires that each Parish Religion program includes in its curriculum a program for self safety for children. We are required to file an attendance report for the program each year at the end of the school year. Parents may attend the program or preview the program before it is presented. It is presented in the classroom by the Director of Religious Education.
In order to be in compliance with the Diocese, please answer the following questions:
If no, do you wish to receive the lesson plans for use at home?
E-Signature of Parent/Guardian (please type out full name):
Date:
USE OF IMAGE WAIVER I hereby grant the parish and/or the Diocese of Tulsa permission to use my child’s image and likeness in any television broadcast, photograph, video, internet site, audio-recording, and in any and all of its publications, including website entries (collectively “promotional materials”) without payment or any other consideration. I understand and agree that these promotional materials will become the property of the parish and/or the Diocese of Tulsa and will not be returned. I hereby irrevocably authorize the parish and/or the Diocese of Tulsa to edit, alter, copy, exhibit, publish or distribute my child’s image or likeness for purposes of publicizing or promoting the parish and/or Diocese of Tulsa’s programs, or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my own/my child’s likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the promotional materials. I also understand that, should I refuse to initial here, this will not preclude my child from participation.
Initials of Parent/Guardian (or indicate "No"):
COMMUNICATION/SOCIAL MEDIA CONSENT I understand that social media (Facebook, Twitter, Google+, etc.) and/or cellular communication (cell phone, texting, Fast Follow) can be a great way to inform my child of events, youth functions, catechetical opportunities, and service projects—if my child has access to any of these media. I acknowledge that these media may be used to inform my child of upcoming events. I hereby grant the parish and/or the Diocese of Tulsa permission to communicate with the participant through social media. I acknowledge that the primary purpose of such communication shall be for providing information related to ministries or events and not for socialization, counseling, or other personal interaction. I also understand that, should I refuse to initial here, this will not preclude my child from participation.
Initials of Parent/Guardian (or indicate "No"):
CONDUCT POLICY I hereby acknowledge the participant is to maintain conduct in a manner consistent with the policies of the parish and/or the Diocese of Tulsa. I understand that failure to do so may result in my child being required to leave the RE/youth activity and/or to discontinue participation in future youth programs and activities at the discretion of the parish, school, and/or the Diocese of Tulsa. Understanding this, my child and I commit to the following (Parent/Participant 12 years of age and older initial each):
My child will not possess, obtain, use, or abuse alcohol, tobacco, or any other illegal substances. I understand that failure to abide by this rule will result in my child’s immediate dismissal from the RE/youth activity. I also understand that my child may be required to discontinue participation in future RE/youth activities at the discretion of the parish, school, and/or the Diocese of Tulsa.
Initials of Parent/Guardian:
Initials of EACH Participant 12 years of age and older, separated by comas (if 11 or younger, please say Not Applicable):
My child will not possess, obtain, or use a weapon of any kind, including pocket knives. I understand that failure to abide by this rule will result in my child’s immediate dismissal from the RE/youth activity. I also understand that my child may be required to discontinue participation in future RE/youth activities at the discretion of the parish, school, and/or the Diocese of Tulsa.
Initials of Parent/Guardian:
Initials of EACH Participant 12 years of age and older, separated by comas (if 11 or younger, please say Not Applicable):
My child will maintain decorum and discipline. I understand that, should a discipline problem arise and my child is involved, my child will be immediately dismissed from the activity. I also understand that my child may be required to discontinue participation in future RE/youth activities at the discretion of the parish, school, and/or the Diocese of Tulsa.
Initials of Parent/Guardian:
Initials of EACH Participant 12 years of age and older, separated by comas (if 11 or younger, please say Not Applicable):
I certify to you that the information contained herein is true and correct to the best of my knowledge and that I fully understand the terms and legal consequences of my execution of this ANNUAL REGISTRATION/CONSENT RE/YOUTH ACTIVITIES.
E-Signature of Parent/Guardian (please type out full name):
Date:
E-Signature(s) of EACH Participant 12 years of age and older, separated by comas (if 11 or younger, please say Not Applicable):
