SACRED HEART RE REGISTRATION FORM

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

Religious Education Program REQUIRED Manning 1st-6th grade Manilla 1st-7th grade Manning 7th grade Manning/Manilla 8th grade Confirmation (Classes Held In Manning) Manning 9-12 CYO Manilla 9-12 CYO Please fill out this field.

Parent or Guardian Information

Father's Information

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

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

Father's Workplace Please enter valid data.

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.

Home Address REQUIRED Please fill out this field. 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.

Mother's Information

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

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

Mother's Workplace REQUIRED Please fill out this field. Please enter valid data.

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.

Home Address REQUIRED Please fill out this field. 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.

Communication Preferences (Select all methods you regularly check) Phone call Text Email Mail Facebook I give permission to send text messages regarding Religious Education classes and programs to my cell phone. I am a member of the 'Sacred Heart Catholic Church - Manning/Manilla' Facebook Group

Other forms of communication

Volunteer Support (It takes many volunteers to make a successful program. Please share your interest in helping out.) Catechist Office Help Family Support Coffee and rolls Children's Liturgy during Mass Special Events (Trunk or Treat, Advent program, Lenten program, End-of-year celebration, etc.)

Student Information

BEHAVIOR EXPECTATION OF STUDENTS

It is important to follow the directions of the adult leader(s) at all times. I understand that as a participant I have the responsibility to help make the classroom and activities a safe experience for everyone through my behavior and conduct. I also understand the danger of not following rules and directions and agree to follow them.
Please check agree below if you and your children agree to the behavior expectations.

I Agree Please select this field.

To be read and agreed upon by parent of guardian

I understand that my child must be healthy in order to safely participate in Sacred Heart religious education class and activities and that I will inform the Faith Formation Director of any medication, ailment, condition or injury that may affect his/her ability to participate safely.
Please click 'agree' below.

I Agree Please select this field.

Medical Emergency Parental Permission*

The health history for my child is correct and complete to my knowledge. If an injury or other medical condition occurs or arises, I hereby give permission to Sacred Heart Catholic Church staff or volunteers to provide routine first aid and seek emergency treatment including x-rays or routine tests. I agree to release of any record necessary for treatment, referral, billing or insurance purposes.
I understand that I am financially responsible for charges and hereby guarantee full payment to the attending physicians or health care unit. In the event of an emergency where I cannot decide for my child, I give permission to the physician/hospital selected by the Sacred Heart Catholic Church staff and volunteers to secure and administer treatment for my child, including hospitalization.
(*If you cannot agree to this section of the form for any reason, contact the Faith Formation Director or Priest regarding a legal waiver in order to attend and participate.)
Emergency Medical 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.
Please click agree below.

I Agree Please select this field.

Emergency Contact: List the name of a friend or relative we can contact if we are unable to reach you in an emergency.

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

Publicity/Image/Voice Permission

Sacred Heart Catholic Church may take photographs, video and/or tape recordings of our programs. During activities, a photograph or video/audio recording may be taken of you or your child. Unless you request otherwise, your agreement below will be considered permission for Sacred Heart Catholic Church to photograph, film, audio/video tape, record and/or televise your image and/or voice or the image and/or voice of your child for use in any publications or promotional materials, in any medium now known or developed in the future without any restrictions. If you object to Sacred Heart using you or your child's image or voice in this manner, please notify the adult leader.
Please click agree below.

Relationship to student REQUIRED Please fill out this field. Please enter valid data.

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

I Agree Please select this field.

Assumption of Risk and Release of Liability

(Please read carefully) I give permission for my child(ren) to participate in the Sacred Heart Catholic Church Religious Education Program. I understand that Sacred Heart classes/activities/events may involve certain risks of physical activity and possible injury and that Sacred Heart Catholic Church will provide each participant with reasonable care, but that Sacred Heart cannot guarantee that my child will remain free of injury. I nonetheless wish to have my child participate in the Sacred Heart Catholic Church Religious Education Program and ASSUME the RISK of participating. I agree to RELEASE from LIABILITY, INDEMNIFY and HOLD HARMLESS the Sioux City Diocese, St. Rose of Lima, Sacred Heart Catholic Church and their employees and volunteers (hereinafter the RELEASES) from any and all claim and/or cause of action arising out of and related to any injury, loss, penalties, damage, settlement, costs or other expenses or liabilities that occur as a result of my child's participation in the religious education program. This release, however, is not intended to release the above-mentioned RELEASES from liability arising out of their sole negligence.
Please click agree below.

I Agree Please select this field.

Send text messages to my phone about cancelations or other information about Religious Education using FLOCKNOTE REQUIRED Please fill out this field.

Flocknote Messaging

Parent Name Please enter valid data.

Phone Number Please enter valid data.

Parent Name Please enter valid data.

Phone Number Please enter valid data.

St. Rose of Lima Parish

Denison, Manning, Vail, Manilla, Charter Oak, Dow City, Iowa

SACRED HEART RE REGISTRATION FORM

2024-2025 Registration

Parent or Guardian Information

Student Information

BEHAVIOR EXPECTATION OF STUDENTS

To be read and agreed upon by parent of guardian

Medical Emergency Parental Permission*

Publicity/Image/Voice Permission

Assumption of Risk and Release of Liability

Flocknote Messaging