REGISTRATION FORM FOR RELIGIOUS EDUCATION

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(2020-2021) St. Anthony of Padua Catholic Church, Falls Church, VA

Please fill out a form for each child.

Is the family registered in the parish?

Yes

I would like to register in the parish

I am currently registered in another parish

Clear selection

Do you prefer classes in English or Spanish for your child?

English

Spanish

Clear selection

Please choose a session: *

FIRST Year of First Communion: Classes will be online. Cost: $80.

SECOND Year of First Communion: 2nd and 4th Tuesday of the Month IN-PERSON from 6:15pm to 7:45pm. 1st and 3rd Tuesday of the Month ONLINE. Cost: $80.

Continued Faith Formation (Children from 3rd to 6th grade who have already received First Communion and desire to continue their faith formation): Classes will be online. Cost: $50.

FIRST Year of Confirmation: 2nd and 4th Tuesday of the Month IN-PERSON from 6:30pm to 8:00pm. 1st and 3rd Tuesday of the Month ONLINE. Cost: $80.

SECOND Year of Confirmation: 1st and 3rd Tuesday of the Month IN-PERSON from 6:30pm to 8:30pm. 2nd and 4th Tuesday of the Month ONLINE. Cost: $80.

FIRST Year of RCIC-2022 (Children who are preparing for Baptism, First Communion, and Confirmation): 1st and 3rd Tuesday of the Month IN-PERSON from 6:15pm to 7:45pm. 2nd and 4th Tuesday of the Month ONLINE. Cost: $80.

SECOND Year of RCIC-2021 (Children who are preparing for Baptism, First Communion, and Confirmation): 1st and 3rd Tuesday of the Month IN-PERSON from 6:15pm to 7:45pm. 2nd and 4th Tuesday of the Month ONLINE. Cost: $80.

I would like to teach my child from home. Fee: $80.

STUDENT INFORMATION

Please fill in the child's information as it appears on the birth certificate.

Child's LAST NAME (as it appears on the birth certificate): *

Child's FIRST NAME (as it appears on the birth certificate): *

Child's MIDDLE NAME (as it appears on the birth certificate):

Sex of the child: *

Male

Female

Date of birth: *

YYYY

Place of birth (city, state, country) (as it appears on the birth certificate): *

Child's Place of Residence

Street (building and apartment number if applicable): *

City: *

State: *

Zip code: *

Child lives with: *

Mother and father

Only with mother

Only with father

Other:

How old will the child be in September of 2020?

Grade Fall 2020: *

What school will the child attend in Fall of 2020?

Did your child attend the Religious Education Program last year (2019-2020)? *

Yes

If your child attended religious education classes in another parish, please state the name of the parish:

Name of siblings who will also be enrolled in the program this school year:

SACRAMENTAL INFORMATION

Has the child been baptized? *

Yes

Date of baptism (if baptized):

YYYY

Name and place of the parish in which the child was baptized (if baptized):

Has the child received First Penance (First Confession)? *

Yes

Has the child received First Communion? *

Yes

Date of First Communion (if applicable):

YYYY

Name and place of the parish in which the child received First Communion (if applicable):

Has the child received Confirmation? *

Yes

Date of Confirmation (if applicable):

YYYY

Name and place of the parish in which the child received Confirmation (if applicable):

What sacrament(s) does your child need? *

First Communion

Confirmation

Baptism, First Communion, and Confirmation (My child is 7 years old, or older, and has not been baptized)

Required

INFORMATION ABOUT YOUR CHILD

If your child has any special needs, please list them here:

If your child has any medical needs, please list them here:

If your child has any allergies, please list them here:

FATHER'S INFORMATION

Father's LAST NAME(s): *

Father's FIRST NAME: *

Language(s) the father speaks:

English

Spanish

Vietnamese

Tagalog

Other

Does the father have legal custody of the child?

Yes, without restrictions

Parents are separated and have joint custody

Clear selection

CIVIL STATUS of the father:

Single

Married in the CHURCH to the child's mother

Married CIVILLY to the child's mother

Married with a different person (who is not the child's mother)

Separated

Divorced

Widow

I am not sure: I would like to speak to a Priest

Clear selection

Father's religious beliefs:

Catholic

Orthodox

Protestant

Other

Other:

Clear selection

Father's email:

Father's phone number(s): *

MOTHER'S INFORMATION

Mother's LAST NAME(s): *

Mother's FIRST NAME: *

Language(s) the mother speaks:

English

Spanish

Vietnamese

Tagalog

Other

Does the mother have legal custody of the child?

Yes, without restrictions

Parents are separated and have joint custody

Clear selection

CIVIL STATUS of the mother:

Single

Married in the CHURCH to the child's father

Married CIVILLY to the child's father

Married with a different person (who is not the child's father)

Separated

Divorced

Widow

I am not sure: I would like to speak to a Priest

Clear selection

Mother's religious beliefs:

Catholic

Orthodox

Protestant

Other

Other:

Clear selection

Mother's email:

Mother's phone number(s): *

INFORMATION FOR CHILD'S PICK-UP/DROP-OFF AND EMERGENCY CONTACTS

Does the parish need a copy of a custody agreement? *

Yes

Name of the person who will be the emergency contact AND who is authorized to pick-up the child (other than mom or dad): *

The emergency contact's phone number: *

Relationship to the child (Ex: Uncle): *

If the need arises, I give permission for my child to receive emergency medical care while participating in the Religious Education Program. *

Yes

CONSENT FOR PHOTOGRAPHY/VIDEOS/AUDIO:

I hereby authorize the Catholic Diocese of Arlington, its parishes and/or schools to use and publish the photographs and/or motion picture or video for which my child/ren posed, and/or any voice recordings. I agree that the Catholic Diocese of Arlington, its parishes and/or schools may use such photographs of my child/ren with or without his/her name and for any lawful purpose, including, for example, publicity, illustrations, bulletins, news and web content. *

Yes (with or without his/her name)

Yes (only without his/her name)

Other:

CODE OF CONDUCT:

I agree that my child and I shall abide by the rules and expectations outlined below. I have reviewed them and discussed the rules and consequences with my child prior to signing this form. I agree that if my child chooses to disregard the Code of Conduct, they may be restricted from future attendance at the center without the possibility of a refund. *

I will arrive to class on time and be ready to learn

I will not prevent others from learning

I will respect others and expect the same respect

I will be kind, with words and actions

If others do not follow these rules, I will notify my catechist

I will attend Mass every Saturday/Sunday and Holy days of obligation with my family

Required

SAFE ENVIRONMENT/CHASTITY TRAINING:

The parish offers a safe environment/chastity training every year.

I give permission for my child to participate

I choose to EXCLUDE my child from this training (he/she will NOT participate)

Clear selection

CONSENT FOR ONLINE EDUCATION PLATFORMS:

I hereby give permission for my child to participate in the online educational platforms, such as: Google Classroom, Google Meet, Zoom Meeting, GotoMeeting, Youtube, etc.

NO, my child may NOT participate.

If my child uses the camera and microphone features on these platforms, my permission is implied and granted.

I understand online educational meetings may be recorded per diocesan policy. If I do not wish for my child to be recorded, it is my responsibility to ensure the camera/microphone is turned off.

I further understand that there is a potential of third-party interference (hacking), and therefore, I will be monitoring each session. I have spoken to my child about what to do should this occur.

I also understand that students/parents/guardians should not take photos, screenshots, or record any video or audio, from these conference sessions.

Should I choose to opt-out of online educational platforms, I must arrange with my parish faith formation leader to homeschool my child(ren).

ADDITIONAL INFORMATION

Name of person completing this form:

Parent Volunteers:

Please check this box if one or both parents wish to volunteer in the Religious Education Program

Payment method. I would like to pay the following way:

Credit Card (please see the Religious Education page on the parish website)

Check (please send a check payable to 'St. Anthony of Padua Catholic Church' addressed to the Office of Religious Education. Memo: RE Registration)

Cash (an office staff member will contact you to make an appointment)

Clear selection

This is the end of the form. Click 'submit.' Please fill out a form for EACH child who will be enrolled in religious education classes.

An office staff member will contact you after receiving your registration form.

Submit

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