July 1, 2017 Dear Parents, Our Faith Formation Program for the 2017
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July 1, 2017 Dear Parents, Our Faith Formation Program for the 2017-2018 academic school year will begin on Wednesday, October 4, 2017. Classes will be held from 6:00 p.m. to 7:30 p.m. in the school unless otherwise noted. Our Faith Formation calendar will be forthcoming in the next few weeks. We coordinate our calendar with the Waterford School District to avoid potential conflicts. In the registration packet, you will find forms for registration, medical treatment authorization, parental information, baptismal information, volunteer sheet, policies and expectations and a peanut free snack list. Even though you may have filled out these forms last year, we must keep up-to-date forms as information may have changed and forms are only good for that specific calendar year. If your child was baptized somewhere other than St. Benedict, we will need an updated baptismal certificate from the church where your child was baptized with notations. If your child was baptized at St. Benedict, please let us know approximately the month and year of baptism. If you are an unregistered family, please contact the Parish Center at 248-681-1534, ext. 204 for information on registration. Thank you for your cooperation in helping us prepare for another year of learning for our students. Registration paperwork can be submitted to the Parish Center. Please register early to help us prepare for the upcoming school year. Have a wonderful summer! See you soon! God bless you. Gloria Armstrong Vicki Krier Parishioner Fees: 1 child/$85, 2 children/$95 FOR OFFICE USE: St. Benedict Parish 3 children/$10 ($10 for each additional child) Amount due: ___________ Faith Formation Program 2017-2018 Non-Parishioner Fees: 1 child/$135, 1st - 8th Grades 2 children/$145, 3 children/$155 Amount paid: __________ Class Schedule – Wednesday evenings ($10 for each additional child) Date: _________________ Sacramental Fees for 1st Communion & Confirmation Check #: __________ 6:00 p.m.-7:30 p.m., School First Communion -$20 Confirmation Retreat Fee-TBD Cash: _____ PLEASE PRINT, FILL OUT BOTH SIDES, and SIGN THE BACK PAGE Family Last Name: ________________________________________________ Home Phone: __________________________ E-mail address:_______________________________________________________________ Address: ________________________________________________________________ City: ____________________________________ Zip:_____________________ Parishioner: Yes _____ No _____ Envelope #___________________ Parents: Father’s Name: ________________________________________________ Cell Phone: _____________________________________ Work phone:_________________________________ Mother’s Name: _______________________________________________ Cell Phone: _____________________________________ Work phone:_________________________________ Student’s First and Last Name M/F Birthdate Grade Baptized(Y/N) Special Needs (Allergies/Medications) 1.___________________________________ _________ _______________________________ _________ ________ ______________________ 2.___________________________________ _________ _______________________________ _________ _________ _____________________ 3.___________________________________ _________ _______________________________ _________ _________ _____________________ Alternate Fee Arrangement: I can help: Complete this section if your child needs Sacramental Preparation in 2017-2018 ____I need an alternate payment plan ___ Catechist Name: ___________ __________ First Eucharist___Reconciliation___Confirmation___ ___ I am unable to pay the fee ___ Hall monitor Name: _____________ ________ First Eucharist___Reconciliation___Confirmation___ ___ I have added additional funds to ___ Class helper Name: _____________________ First Eucharist___Reconciliation___Confirmation___ assist others Emergency Name and Phone (if you cannot be reached) Name__________________________________________________ Relationship ____________________________________________________ Home phone ______________________________________ Cell phone________________________________________ MEDIA RELEASE I (We) give permission for St. Benedict parish, Waterford, MI, to publish or disclose in parish-related newsletters, websites, or other media-related vehicles, any photos, videos, audios or other materials in which I or my child/children may have appeared, spoken, written or otherwise been represented. My signature below releases representatives of St. Benedict to use any of this material. A copy of this release will be kept on file. It may be revoked at any time. ______________________________________________________________________________________________________________________ Parent(s) or Legal Guardian Date (For those families with more than 3 children) Student’s First and Last Name M/F Birthdate Grade Baptized (Y/N) Special Needs (Allergies/Medications) 4._______________________________ _____ ___________ ________ _________________ _____________________________ 5. _______________________________ _____ ___________ ________ _________________ _____________________________ MEDICAL TREATMENT AUTHORIZATION FORM To Whom It May Concern: As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me. Student’s Name:_____________________________Relationship to you:_________________________________________ (if more than one child, please list their names on the back of this form) Address:_____________________________________________________________Phone:____________________________ Type of activity or school year for which release is intended:__________________________________________________ PARENTS/LEGAL GUARDIANS Father Address Phone Mother Address Phone Where parents can be reached when not at home: Father Address Phone Mother Address Phone Family Physician:__________________________________Phone_______________________ Physician Address:_________________________________City:_________________________ List allergies, medication, contract or other pertinent comments: Health Insurance Data: Company:_____________________________________Policy:__________________________ Group:_______________________________________Contract:________________________ List a neighbor or close relative who will assume care of your child if you cannot be reached. Name:_____________________________________Relationship to child:_________________________________________ Address:___________________________________Phone:____________________________ I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed of my own free will with the sole purpose of authorizing medical treatment deemed necessary and appropriate by the treating physician. Date:___________________________Signed:________________________________________ (Parent or Guardian) June 2017 ST. BENEDICT PARISH FAITH FORMATION PARENTAL INFORMATION 2017-2018 Family Name:_______________________________________Phone:____________________________________ Address:______________________________________________________________________________________ School District/Private School:_____________________________________ Email Address:__________________________________________________ (will be used for all communication and in the event of class cancellation) Parental Information: Father’s Full Name:_________________________________Mother’s Full Name:)________________________ Religion:__________________________________________Religion:____________________________________ Phone(w):__________________Cell:__________________ Phone(w):_________________Cell:_____________ Marital Status: Married Divorced Separated Widowed Single Child/Children reside with: Both Parents Father Mother Stepmother Stepfather I have received, read and agree to the St. Benedict Faith Formation Policies and Procedures: Please sign and date here I give permission for St. Benedict Faith Formation Department to publish my child’s(children) name(s) and photo in the parish bulletin (Messenger) on Faith Formation projects and/or activities: Please sign and date here ST. BENEDICT FAITH FORMATION 2017-2018 BAPTISMAL INFORMATION Dear Parents, We need a copy of your child’s(children) Baptismal record for our Faith Formation Program. If your child was baptized at St. Benedict Church, please indicate the approximate date (unless you have the date) and we will check our sacramental books and record the information. If you child was baptized at another parish, please call the parish where your child was baptized and request a baptismal certificate. Baptized at St. Benedict (indicate approximate month/year):____________________________ Baptized at church other than St. Benedict: Church____________________________Date of Baptism:___________(Please provide certificate) Name of Child:________________________________________________________________ Date of Birth:_________________________ Father’s complete legal name:___________________________________________________ Mother’s complete legal name (maiden):_________________________________________ Name of Child:________________________________________________________________ Date of Birth:_________________________ Father’s complete legal name:___________________________________________________ Mother’s