CCD/PSR Registration (2021-2022)
St. Joseph the Worker Parish 229 California Ave. Weirton, WV 26062 Tel#: 304-723-2054
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Email *
Name *
Date of Birth *
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Grade *
Student's Current Home Address *
Allergies/Medical Conditions *
Mother's Name (First, Middle, Last) *
Mother's Maiden Name *
Mother's Cell Phone #, Email Address, & Mailing Address (if different from above, otherwise, enter "same as the above") *
Father's Full Name *
Father's Cell Phone #, Email Address, & Mailing Address (if different from above, otherwise, enter "same as the above") *
Who does the child live with? *
If "Other," please explain, otherwise, enter "N/A" (not applicable) *
If student lives with one parent,  please indicate who has legal custody and/or if child also lives with stepparent. Otherwise, enter "N/A." *
Does this student have any medical or learning disabilities or food allergies? *
Is there anyone your child should not be picked up by? *
If "Yes" - by whom? If "No" - type N/A *
Name of Primary Contact (Parent/Legal Guardian) *
Primary Contact's Relation to Student *
Primary Contact's Cell Phone #, Email Address, & Mailing address *
Secondary Contact's Name, Relation to student, Phone Number, & Email (Optional)
Is child baptized? (If this student is being registered for the first time, please provide a Baptism certificate to the parish office) *
If yes, date of baptism
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Church where child was baptized (include city & state). *
Please check the other sacraments the student has received *
Required
Please indicate which of the choices below most accurately reflects your current faith practice as a family *
Required
Registration Fee ($25.00) - This helps cover the cost for texts, materials, food, etc. (Please drop off all cash and check payments to the Parish Office) *
Book Fee (Image of God Series by Ignatius Press) [Cash, Check: make payable to "St. Joseph the Worker Catholic Church," or Venmo: @stjosephtheworkerdre] *
Checklist (Print, sign, & email to joetheworkerdre@gmail.com or drop off at parish office at 229 California Ave. Weirton, WV 26062) - You can also pick up and complete the forms at the Parish Office
Photo Release Form: I release and assign to St. Joseph the Worker and the Diocese of Wheeling-Charleston all rights to the video, sound recordings, and/or photographs made by my child during all CCD/Parish School of Religion (PSR) 2021-2022 school hours and events. I authorize reproductions, sales, copyright, exhibition, broadcast and/or distribution of said video, sound recordings, and/or photographs without limitation for general religious and promotional purposes of the Diocese of Wheeling-Charleston. I release individually on behalf of my minor child, the Diocese of Wheeling-Charleston, its agents and employees from any and all claims, damages, liabilities, costs, and expenses which I now have or may hereafter have arising out of the making or use of such video, sound recordings, and/or photographs. I understand that I may withdraw this authorization in writing at any time. I further understand that refusing to grant this consent will in no way affect the scholastic or extracurricular services my child receives.   *
CCD/PSR 2021-2022 - St. Joseph the Worker Parish  Waiver (Release) of Liability and Hold Harmless (Indemnity) Agreement (Form): I do, hereby, via my electronic signature (enter your First & Last Name) indicated below, waive all claims, release, indemnify, defend, safeguard, and hold harmless St. Joseph the Worker Catholic Church and the Diocese of Wheeling Charleston, its employees, and volunteers, from and against any claims, losses, damages, lawsuits, costs including, without limitation, attorney fees), and liabilities, in the case of my child/children – at CCD/PSR 2021-2022 sustaining any injuries at a parish or parish school facility. *
Opt-out form for use with the Touching Safety program: St. Joseph the Worker CCD/PSR 2021-2022 will present a sexual abuse prevention program, the Touching Safety program, to our students in Preschool through 8th  grades. The creators of the Protecting God’s  Children  program  developed  the  Touching  Safety  program.  This  program  is  provided  to  us  by  the Diocese  of  Wheeling-Charleston  and  is  a  part  of  our  ongoing  effort  to  help  create  and  maintain  a  safe environment for children and to protect all children from sexual abuse. As a parent, you have the right to choose whether your child participates. You are more than welcome to look over  the  lesson  plan  ahead  of  time  so  you’ll  be  aware  of  the  nature  of  the  Touching  Safety  program.  The program is  also available for you if you would  like to facilitate  it yourself.  If you have questions about the program or the lessons, please contact Mark Tirona at the rectory at 304-723-2054. If you determine that you DO NOT want your child to participate, please select the corresponding "opt-out" option  at the bottom of this page and return it to your child’s catechist or Mark Tirona. For more information on the Touching Safety program, visit the VIRTUS Online website at www.virtus.org. *
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