Catholic Formation Registration – Catholic Formation

Parish Attending Catholic Formation at:

St. Patrick Parish
Immaculate Conception Parish
Both (Depending on grade level)
Homeschool

Specify Current Parish Membership

Or if not registered with a Parish, enter "Unaffiliated"

Child's Name *

First

Last

Sex *

Birthdate *

Grade *

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

Do You Need to Submit a Medication Consent Form?

Yes
No

File Upload Medication Consent Form

Click or drag a file to this area to upload.

Child's Name

First

Last

Sex

Birthdate

Grade

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

Do You Need to Submit a Medication Consent Form?

Yes
No

File Upload Medication Consent Form

Click or drag a file to this area to upload.

Child's Name

First

Last

Sex

Birthdate

Grade

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

Do You Need to Submit a Medication Consent Form?

Yes
No

File Upload Medication Consent Form

Click or drag a file to this area to upload.

Child's Name

First

Last

Sex

Birthdate

Grade

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

Do You Need to Submit a Medication Consent Form?

Yes
No

File Upload Medication Consent Form

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 *

Diocese of Superior Parental Permission for Child & Youth Training Form (Please carefully read the statements below. Indicate your permission or refusal of permission by signing and dating the appropriate statement.) *

YES, I would like my child(ren) to participate in the Charter Safe Environment training described below.
NO, I do not want my child(ren) to participate in the Charter Safe Environment training described below. I understand that if I refuse to allow my child(ren) to participate in this training session, I will receive a resource packet from the parish to help me educate my own child(ren) regarding these important issues.

Immaculate Conception/St. Patrick's will be presenting abuse awareness and resistance training to all children enrolled in catholic formation. This training session is the parishes and the Diocese of Superior's response to the mandates of the United States Conference of Catholic Bishops' Charter for the Protection of Children and Youth: Promise to Protect, Pledge to Heal. Parents and other responsible adults want to protect children from those who might harm them, but no child can be supervised every moment of the day. This training will help your child recognize unhealthy relationships, appropriate ways to reduce the likelihood of being abused, and how to get help from others. Most importantly, this information will be presented to your child in a manner that reinforces his/her value as a person created in the image and likeness of God who deserves love and respect. THE TRAINING DATE FOR THE 2024-2025 SESSIONS WILL BE 11/13/2024 FOR IMMACULATE CONCEPTION AND 11/17/2024 FOR ST. PATRICK'S. The Diocesan Department, Parish or School Initiating this form is: Immaculate Conception Church. The contact person is: Kristin Dittman. Phone 715-246-4652 ext 260. Email: k.dittman@ic-church.com. Fax: 715-246-2526. So that we may respect your wishes . . . please indicate below your permission or refusal for your child to participate in this training session above and sign below. It is important for us to have your signed consent or refusal on file. Emails and phone calls are not acceptable.

Child & Youth Training Form Signature *

Please type your name above to affirm your choice regarding the Child & Youth Training Form permission.

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. Please carefully read the statements above. Indicate your permission or refusal of permission by selecting the appropriate statement above and typing your name below.

Youth Image and Recording Release Signature *

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

Upload Baptismal Certificates (if baptized outside IC or SP Parishes)

Click or drag a file to this area to upload.

I plan to pay for Catholic Formation Tuition by:

On-line Payment. Please use the link to the upper left (or below if on a mobile phone).
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

I am interested in volunteering with the CF program to DEFER TUITION. Please look for and fill out the volunteer form on the left if interested (below for mobile users).

Yes
No

I am interested in volunteering with the CF program. Please look for and fill out the volunteer form on the left if interested (below for mobile users).

Yes
No

2024 – 2025 Catholic Formation Registration