Catechesis of the Good Shepherd

Parishioners at: *

St. Patrick Parish
Immaculate Conception Parish
Other

If other, please list parish:

Child's Name *

First

Last

Gender *

Birthdate *

School Grade for the 2025-26 school year (if enrolled): *

Level 1 (3y - Kindergarten) or Level 2 (1st -2nd Grade) *

Session FIRST Choice *

Session SECOND Choice *

Please make a different second choice from your first choice.

Session FIRST Choice *

Session SECOND Choice *

Please make a different second choice from your first choice.

I would like my child to be walked from SMS 3K or Connect-On to CGS. This option is only available for the Friday 7:50-9:10 am session. *

Yes
No

Special Needs: (Medical, Learning Disabilities, Physical Disabilities, Allergies etc.)

Do You Need To Submit A Medication Consent Form?

Yes
No

File Upload Medication Form - Only if Needed

Click or drag a file to this area to upload.

Do you have another child to register?

Yes
No

Child's Name *

First

Last

Gender *

Birthdate *

School Grade for the 2025-26 school year (if enrolled): *

Level 1 (3y - Kindergarten) or Level 2 (1st -2nd Grade) *

Session FIRST Choice *

Session SECOND Choice *

Please make a different second choice from your first choice.

Session FIRST Choice *

Session SECOND Choice *

Please make a different second choice from your first choice.

I would like my child to be walked from SMS 3K or Connect-On to CGS. This option is only available for the Friday 7:50-9:10 am session. (copy) *

Yes
No

Special Needs: (Medical, Learning Disabilities, Physical Disabilities, Allergies etc.)

Do You Need To Submit A Medication Consent Form?

Yes
No

File Upload Medication Form - Only if Needed

Click or drag a file to this area to upload.

Do you have another child to register? *

Yes
No

Child's Name *

First

Last

Gender *

Birthdate *

School Grade for the 2025-26 school year (if enrolled): *

Level 1 (3y - Kindergarten) or Level 2 (1st -2nd Grade) *

Session FIRST Choice *

Session SECOND Choice *

Please make a different second choice from your first choice.

Session FIRST Choice *

Session SECOND Choice *

Please make a different second choice from your first choice.

I would like my child to be walked from SMS 3K or Connect-On to CGS. This option is only available for the Friday 7:50-9:10 am session. (copy) (copy) *

Yes
No

Special Needs: (Medical, Learning Disabilities, Physical Disabilities, Allergies etc.)

Do You Need To Submit A Medication Consent Form? *

Yes
No

File Upload Medication Form - Only if Needed *

Click or drag a file to this area to upload.

Father's Name/Guardian

First

Last

Email

Phone

Mother's Name/Guardian

First

Last

Email

Phone

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact *

First

Last

Emergency Contact's Email *

Emergency Contact's Phone *

We may determine that a 3 year old is not ready for CGS. Readiness is determined by the leaders when looking at various criteria. We will make our determination, if needed, by 12/1/25 and reimburse accordingly: We will offer a full reimbursement for a child we determine is not ready prior to 12/1/25. If we determine that it is best that the child not continue CGS after 12/1/25, we will offer a reimbursement of half of the total registration fee. We are not offering a reimbursement or refund initiated by a parent after the first session is held. Please note: Your child must be toilet-trained to attend CGS. Please add any additional information below that you would like to communicate to us. Thank you!

Diocese of Superior Youth Image and Recording Release Form (Please carefully read the statements below. Indicate your permission or refusal of permission by signing and dating the appropriate statement.) *

YES, I give permission to the Diocese of Superior and affiliated parishes and schools to use my child(ren)'s image and/or recording for above-said use for the child(ren) registered.
NO, I DO NOT give permission to the Diocese of Superior and affiliated parishes to use my child(ren)'s image and/or recording for above-said use for the child(ren) registered.

The Diocese of Superior and its affiliated parishes and schools may wish to use an image and/or recording of your child in print and electronic publicity and virtual education. It is the practice of the Diocese of Superior to protect all children at all times including the public use of their image and/or recording. This document has been developed to inform parents and guardians of their right to grant or refuse permission for their child's image and/or likeness to be used in Diocesan and affiliated parish and school media, promotional materials, and virtual education. Permission to use any video recording, photograph, slide, audio recording, or any other visual or audio reproduction in which your child may appear may include promotional and educational activities such as, but not limited to, websites, social media sites, newsprint, flyers or brochures, virtual classroom. We reserve the right to determine which image and/or recording is used and how long it will remain on the site or is used in media materials. The Diocesan Department, Parish or School Initiating this form is: Immaculate Conception Church. I understand that both print and electronic media have a large audience and that my child(ren)’s photographic image and/or recording may have wide distribution. The contact person is: Kristin Dittman. Phone 715-246-4652 ext 260. Email: k.dittman@ic-church.com. Fax: 715-246-2526.

Youth Image and Recording Release Signature *

Please type your name above to affirm your choice regarding the Youth Image and Recording Release permission.

There is a $20 CGS deposit fee, which goes towards the $80 total registration fee, per child. If preferred to pay in two parts, the balance is due by 10/1/25. A payment in full of $80 can also be made. (financial scholarships are available) (there is also a $200 family max for CGS/CF tuition). I plan to pay for CGS by:

On-line Payment. Please use the link above.
Drop off payment at Immaculate Conception Church Main office
Mail Check (payable to Immaculate Conception Church) to 151 S. Washington Ave, New Richmond, Wi, 54017

Catholic Formation

To register your child for a CGS session, please fill out the registration form below.

Registration Form: