2020-2021 Catholic Faith Formation in Steubenville

[This form is submitted at the BOTTOM of the page]

This form is to register your child for the Parish School of Religion (PSR) Faith and Life program for catechesis and sacramental preparation.

Unfortunately we are not able to offer Catechesis of the Good Shepherd this year.

PSR FEES

FEE: $30 per child for books/materials/etc.

Please make checks payable to: CFF (Catholic Faith Formation).

Questions or concerns, please talk to your Pastor.

There are No Refunds.

PARENTAL INFORMATION

CHILD'S INFORMATION

[This form is submitted at the BOTTOM of the page]

– CHILD 1: first and last name, age, birth date, gender, school, grade
– CHILD 2: first and last name, age, birth date, gender, school, grade
– CHILD 3: first and last name, age, birth date, gender, school, grade
– CHILD 4: first and last name, age, birth date, gender, school, grade
– CHILD 5: first and last name, age, birth date, gender, school, grade

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INSTRUCTION TYPE: We are offering in-person classes, but for those with a COVID risk, we can provide an online option.
-List the name of each child below that needs an online class.
-This is for COVID related reasons only, not sports or other reasons.
-[skip this box if you do NOT need online instruction]

SACRAMENTAL INFORMATION

[This form is submitted at the BOTTOM of the page]

This section is for FIRST time families or FIRST time children ONLY
SKIP this section if you are a returning family

For EACH CHILD, list for EACH SACRAMENT:
Date of sacrament received, Church name, Church address w/city, state, zip
(List Church and address once if it is the same)
– Child's Name
– Baptism
– 1st Confession
– 1st Communion
– Confirmation

EMERGENCY INFO AND MEDICAL AUTHORIZATION

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PURPOSE: To enable parents and guardians to authorize the provision of emergency treatment for children who become ill or injured while under the Catholic Faith Formation program for the City of Steubenville supervision, and when parents or guardians cannot be reached.

———PART I or PART II MUST BE COMPLETED———

PART I:
(To grant consent)
In the event that reasonable attempts to contact me (the signer), at the PRIMARY phone number below or other parent or guardian at the SECONDARY phone number below, have been unsuccessful, I hereby give consent for:

1. The administration of any treatment deemed necessary by:
––a. Preferred physician:
––b. Preferred dentist:
––c. Or in the event the designated preferred practitioner is not available, by another licensed physician or dentist.

2. The transfer of the child to the preferred hospital:
or any hospital reasonably accessible for the condition of emergency.

MEDICAL HISTORY: This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of the surgery. The following are facts concerning the child’s medical history including allergies, medications being taken, and any physical impairment to which a physician should be alerted:

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PART II:
(Refusal of consent)
I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the supervisors to take no action or to:

DIOCESE OF STEUBENVILLE MANDATORY CHILD PROTECTION POLICY REGISTRATION AND PERMISSION FORM FOR PARISH RELIGIOUS EDUCATION

[This form is submitted at the BOTTOM of the page]

NAME OF PARISHS:
Holy Family, Saint Peter, Triumph of the Cross, St. Agnes, Blessed Sacrament, Our Lady of Lourdes

PRIEST COORDINATOR and PHONE NUMBER:
Father Thomas Nau – 740-264-6177

PROGRAM INFORMATION: Director of Religious Education:
- Catechetical Leader: Barbara Van Beveren
- Phone Number: 740-264-6177

- Location: Holy Family Church, St. Peter, Triumph of the Cross, Blessed Sacrament and Our Lady of Lourdes Properties and the Aquinas Catechetical Center

- Events include:: Faith and Life; Sacramental Preparation; Youth Days; Retreats; VBS

- Begins: September 2020
- Ends: June 2021
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I give the children listed on this form ( children listed on this form under my care) MY PERMISSION to attend Catholic Faith Formation Program for the period listed above. I understand that I can contact the catechist, the catechetical leader, or the priest coordinator if I have any concerns about religious education.

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***Posting Pictures on our Website, Diocesan Paper and Bulletin Board***

I give permission for my child’s picture to be posted on the Catholic Faith Formation website and/or the diocesan newspaper, “The Register.” I understand that the pictures will not have my child’s name listed. I also give my permission to post pictures of my child on the All Saints Catechetical Center’s bulletin board.