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2019-2020 Sunday-Monday Small Group Registration

- Our Faith

7th Grade Students do not have weekly small groups so no registration is necessary for 7th grade.
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- Family Name REQUIRED Please fill out this field. Please enter valid data.
- Family Information
- Are you registered parishioners of Saint Monica Parish? REQUIRED Yes No Please fill out this field.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Mailing Address REQUIRED Please fill out this field. Please enter valid data.
- Address 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.
- Father's Name REQUIRED Please fill out this field. Please enter valid data.
- Father's Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Is the Father Roman Catholic? REQUIRED Yes No Please fill out this field.
- Mother's Name REQUIRED Please fill out this field. Please enter valid data.
- Mother's Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Is the Mother Roman Catholic? REQUIRED Yes No Please fill out this field.
- Are there any custody or legal issues? (If yes, please provide a copy of the latest court order.) REQUIRED Yes No Please fill out this field.
- Student Information
- All fields must be completed.
- First time registrants must provide a copy of each child's Baptisimal Certificate.
- Religious Education Students REQUIRED Please fill out this field.
  
  Student 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Please indicate the desired day for small groups. REQUIRED Sunday Monday Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Grade as of September 2019 REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  If you are new to the Saint Monica Religious Education Program, indicate your previous Parish, City and State.
  
  If new to the Saint Monica Religious Education Program, indicate this student's previous religious education experience and grade level completed.
  
  Does this student have any medical conditions, allergies or prescribed medications? REQUIRED
  If this does not apply, please indicate with N/A.
  Please fill out this field.
  
  Does this student have any learning disabilities or use learning support services? REQUIRED
  If this does not apply, please indicate with N/A.
  Please fill out this field.
  
  This student utilizes an Individualized Education Program. REQUIRED No IEP 504 Please fill out this field.
  
  Student 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Please indicate the desired day for small groups. REQUIRED Sunday Monday Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Grade as of September 2019 REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  If you are new to the Saint Monica Religious Education Program, indicate your previous Parish, City and State.
  
  If new to the Saint Monica Religious Education Program, indicate this student's previous religious education experience and grade level completed.
  
  Does this student have any medical conditions, allergies or prescribed medications? REQUIRED
  If this does not apply, please indicate with N/A.
  Please fill out this field.
  
  Does this student have any learning disabilities or use learning support services? REQUIRED
  If this does not apply, please indicate with N/A.
  Please fill out this field.
  
  This student utilizes an Individualized Education Program. REQUIRED No IEP 504 Please fill out this field.
  
  Student 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Please indicate the desired day for small groups. REQUIRED Sunday Monday Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Grade as of September 2019 REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  If you are new to the Saint Monica Religious Education Program, indicate your previous Parish, City and State.
  
  If new to the Saint Monica Religious Education Program, indicate this student's previous religious education experience and grade level completed.
  
  Does this student have any medical conditions, allergies or prescribed medications? REQUIRED
  If this does not apply, please indicate with N/A.
  Please fill out this field.
  
  Does this student have any learning disabilities or use learning support services? REQUIRED
  If this does not apply, please indicate with N/A.
  Please fill out this field.
  
  This student utilizes an Individualized Education Program. REQUIRED No IEP 504 Please fill out this field.
  
  Student 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Please indicate the desired day for small groups. REQUIRED Sunday Monday Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Grade as of September 2019 REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  If you are new to the Saint Monica Religious Education Program, indicate your previous Parish, City and State.
  
  If new to the Saint Monica Religious Education Program, indicate this student's previous religious education experience and grade level completed.
  
  Does this student have any medical conditions, allergies or prescribed medications? REQUIRED
  If this does not apply, please indicate with N/A.
  Please fill out this field.
  
  Does this student have any learning disabilities or use learning support services? REQUIRED
  If this does not apply, please indicate with N/A.
  Please fill out this field.
  
  This student utilizes an Individualized Education Program. REQUIRED No IEP 504 Please fill out this field.
  
  Student 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Please indicate the desired day for small groups. REQUIRED Sunday Monday Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Grade as of September 2019 REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  If you are new to the Saint Monica Religious Education Program, indicate your previous Parish, City and State.
  
  If new to the Saint Monica Religious Education Program, indicate this student's previous religious education experience and grade level completed.
  
  Does this student have any medical conditions, allergies or prescribed medications? REQUIRED
  If this does not apply, please indicate with N/A.
  Please fill out this field.
  
  Does this student have any learning disabilities or use learning support services? REQUIRED
  If this does not apply, please indicate with N/A.
  Please fill out this field.
  
  This student utilizes an Individualized Education Program. REQUIRED No IEP 504 Please fill out this field.
- Volunteer Information
- I am willing to be an active participant in my child's education by: Teaching Religious Education Substituting as a Religious Education Teacher Acting as a Teacher's Aide Substituting as a Teacher's Aide Helping with Clerical Tasks Helping with Drop-off and Pick-Up Procedures I am not able to help.
- 2019-2020 Authorized Student Pick-Up
- No child will be released to any adult whose name is not on-file with the Religious Education Office or without proper identification.
- For your child/children’s protection, please fill out the name or names of authorized persons, other than yourself, who may pick him/her/them up at dismissal. Only those individuals listed on this form will be permitted to pick your child/children up at dismissal if you are not present. A driver’s license may be requested of those individuals authorized below. In case of car pool arrangement, designate such on the line “Relationship”. Please notify the Religious Education Office promptly if any changes are in order.
- Family Name REQUIRED Please fill out this field. Please enter valid data.
- If there is anyone who might come for your child/children to whom you do NOT wish us to release them, please indicate their name and reason below:
- Person Authorized to Pick-Up Student REQUIRED Please fill out this field.
  
  Person Authorized to Pick-Up Student 1
  
  Name Please enter valid data.
  
  Phone Number Please enter a phone number.
  
  Relationship Please enter valid data.
  
  Person Authorized to Pick-Up Student 2
  
  Name Please enter valid data.
  
  Phone Number Please enter a phone number.
  
  Relationship Please enter valid data.
  
  Person Authorized to Pick-Up Student 3
  
  Name Please enter valid data.
  
  Phone Number Please enter a phone number.
  
  Relationship Please enter valid data.
- Consent, Agreements and Notices
- Emergency Notice
  In the case of an emergency, where all attempts at contacting the parent/guardian have failed, I, (parent/guardian) hereby give permission to the Director of Religious Education or individual in charge of Saint Monica’s Religious Education Program to sign for any emergency medical treatment that may be deemed necessary for the proper care and treatment of (child/children) by the medical staff and/or doctor in charge at whatever medical facility it may be necessary to transport our (child/children) to at the time of the emergency.
  I Agree (by clicking "I Agree" you are acknowledging and consenting to the above information). Please select this field.
- Program Expectations:
  Students in the program are expected to follow the rules as stated below. These rules are intended to maintain the safety and well being of the staff and students.
  
  - Students are expected to be cooperative, courteous, respectful at all times.
  
  - Students are expected to follow all directives given by the catechists and director of the program.
  
  - Students may eat only at planned special events within the program. Gum is not permitted.
  
  - Students are expected to be respectful of church and others’ property. Students in the Religious Education Program are not permitted to handle others’ belongings in desks, closets, or classroom in general.
  
  - Students are expected to leave the classroom and school property in the condition in which it was found prior to class.
  
  Consistent failure to follow these directives may result in a conference among the Pastor, Director, parents, and student.
  I Agree (by clicking "I Agree" you are acknowledging and consenting to the above information). Please select this field.
- Parent Agreement
  We realize our obligation as Catholic parents to ensure our child/children’s regular attendance at Religious Education classes, weekly Mass, and Holy Days of Obligation. We also acknowledge the requirement to attend sacramental meetings, if applicable. We understand that failure to meet these obligations could result in the postponement of our child/children’s reception of the sacraments and/or promotion to the next grade level of their religious studies.
  
  We also ask the families do their best to keep absences to a minimum during the 2019-2020 Religious Education Program. When absences occur ask the small group leader for make-up work.
  I Agree (by clicking "I Agree" you are acknowledging and consenting to the above information). Please select this field.
- Photo / Video / Social Media Release
  I, hereby give the Archdiocese of Philadelphia/Saint Monica Church, its successors and assigns and those acting with authority, the unqualified right and permission to reproduce, copyright and circulate pictures and/or video of my child produced and filmed by the Archdiocese of Philadelphia and/or Saint Monica Church. I understand I will be contacted in advance for permission to publish my child’s name.
  
  I hereby warrant that I am free to give this permission. I further warrant that the information I have provided is to the best of my knowledge, true and accurate.
- Photo / Video / Social Media Release 2019-2020 Yes, I do give my consent. No, I do not give my consent.
- Program Fee for 2019-2020 REQUIRED
  Confidential financial assistance is available upon request. Fees are non-refundable.
  190 – 1 child 370 – 2 Children 500 – 3 or more children Please fill out this field.
Total:

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2019-2020 Sunday-Monday Small Group Registration

Family Information

Student Information

Volunteer Information

2019-2020 Authorized Student Pick-Up

Consent, Agreements and Notices