Sacred Heart Parish

222 E. Fremont St.

Appleton, WI 54915

920-739-3196

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2021 / 2022 Registration Forms

FAITH FORMATION REGISTRATION FORM
- The maximum number of form submissions has been reached. This form is currently not available.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
  HEAD OF HOUSEHOLD
  
  Family Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Registered Member: REQUIRED Sacred Heart Parish St. Bernadette Parish Other Please fill out this field.
  
  If other, please provide. Please enter valid data.
  
  FATHER'S INFORMATION
  
  Father's Last Name: Please enter valid data.
  
  Father's First Name: Please enter valid data.
  
  Father's Email: Please enter an email address.
  
  Father's Phone/Cell Number: Please enter a phone number.
  
  Father's Occupation: Please enter valid data.
  
  Father's Religion: Catholic Other
  
  If other, please provide. Please enter valid data.
  
  MOTHER'S INFORMATION
  
  Mother's Last Name: Please enter valid data.
  
  Mother's First Name: Please enter valid data.
  
  Mother's Email: Please enter an email address.
  
  Mother's Phone/Cell Number: Please enter a phone number.
  
  Mother's Occupation: Please enter valid data.
  
  Mother's Religion: Catholic Other
  
  If other, please provide. Please enter valid data.
  
  ADDITIONAL INFORMATION
  
  Is there anything in addition we should be aware of regarding the family dynamics? (divorce, raised by grandparents, deceased parent, etc.? Please explain.
  
  EMERGENCY CONTACT INFORMATION
  
  Emergency Contact Last Name: (other than listed above) Please enter valid data.
  
  Emergency Contact First Name: Please enter valid data.
  
  Emergency Contact Relationship to Child: Please enter valid data.
  
  Emergency Contact Phone/Cell Number: Please enter a phone number.
  
  STUDENT REGISTRATION
  
  Number of Students to Register 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.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter a date.
  
  Grade: REQUIRED Please fill out this field.
  
  This year, 2021/2022 my child is looking to receive:
  
  Special Needs (medical, allergies, learning / physical disabilities) or N/A
  
  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.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter a date.
  
  Grade: REQUIRED Please fill out this field.
  
  This year, 2021/2022 my child is looking to receive:
  
  Special Needs (medical, allergies, learning / physical disabilities) or N/A
  
  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.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter a date.
  
  Grade: REQUIRED Please fill out this field.
  
  This year, 2021/2022 my child is looking to receive:
  
  Special Needs (medical, allergies, learning / physical disabilities) or N/A
  
  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.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter a date.
  
  Grade: REQUIRED Please fill out this field.
  
  This year, 2021/2022 my child is looking to receive:
  
  Special Needs (medical, allergies, learning / physical disabilities) or N/A
  
  2021/2022 VOLUNTEER SIGN UP
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Catechist (if yes, please select the grade)
  
  Substitute Catechist (if yes, please select the grade)
  
  Classroom Aide (if yes, please select the grade)
  
  Hall Monitor (1 week each month)
  
  Parking Lot Attendant (1 week each month)
  
  My family can volunteer in the parish (1 weekend each month)
  
  I am able to help with events in the following ways
  
  FAMILIES FOR CHRIST
  
  A parent group that meets with the Family Ministry Team staff to brainstorm exciting family activities, build community within the parish, meets monthly and to get acquainted with other parents.
  
  I am interested in joining. Please select which parish group.
  
  U.S. BISHOP'S DIRECTIVES
  
  All volunteers working with children under 18 years of age or vulnerable adults will be asked to comply with the U.S. Bishop's directives to ensure the protection of our children and vulnerable adults in all ministries sponsored by the parish.
  
  This includes:
  
  A background check
  
  Signature on the Diocesan "Code of Conduct"
  
  Completion of VIRTUS training
  
  Thank you for your commitment! Any questions, please call Gina at 920-739-4157 or email lead@faithministryteam.org
  
  2021/2022 CONSENT FOR SOCIAL MEDIA
  
  The following questions are required by the diocese of Green Bay for all students enrolled in youth programs of the parish.
  
  Number of Minors REQUIRED Please fill out this field.
  
  Minor Name 1
  
  Communication electronically, via email, text, social media or other digital means, in accordance with the Safe Environment Social Communication Policy for the Diocese of Green Bay by parish, catechists, youth leaders.
  https://www.gbdioc.org/protecting-our-children/safe-environment
  
  I give permission to digitally communicate with my child. Yes No
  
  Authorize and consent that Faith Formation Program, the Diocese of Green Bay and anyone authorized by Faith Formation or Diocese of Green Bay be permitted to use and publish for general communication, advertising, commercial and publicity purposes, the likeness of my child and my child’s original work for any other lawful purpose whatsoever, including video, audio, photographic portraits, pictures, reproductions, quotations, made through any medium, including social or other electronic media, in accordance with the Safe Environment Social Communication Policy for the Diocese of Green Bay.
  https://www.gbdioc.org/protecting-our-children/safe-environment
  
  Media Release - I authorize and consent. Yes No
  
  The following questions are required by the Diocese of Green Bay for all students enrolled in youth programs of the parish.
  
  This statement of intent, and if indicated – consent, is valid for one year. If I choose to rescind my consent to the Authorization, I agree that I will inform Faith Formation in writing and that my rescission will not take effect until it is received by Faith formation. I understand however, that it may not be possible to recall any worker photos that have been published prior to receipt of my written rescission.
  
  As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("participant"). I agree on behalf of myself, my child name therein, or our heirs, successors, and assigns, to hold harmless and defend Faith Formation / Youth Ministry its officers, directors, employees and Faith Formation / Youth Ministry agents, and the Diocese of Green Bay, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending therewith, and I agree to compensate the parish/school, its officers, directors and agents, and Diocese of Green Bay its employees and agents and chaperones, or representative associated with the event for reasonable attorney's fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school or the Diocese of Green Bay.
  
  Minor Name 2
  
  Communication electronically, via email, text, social media or other digital means, in accordance with the Safe Environment Social Communication Policy for the Diocese of Green Bay by parish, catechists, youth leaders.
  https://www.gbdioc.org/protecting-our-children/safe-environment
  
  I give permission to digitally communicate with my child. Yes No
  
  Authorize and consent that Faith Formation Program, the Diocese of Green Bay and anyone authorized by Faith Formation or Diocese of Green Bay be permitted to use and publish for general communication, advertising, commercial and publicity purposes, the likeness of my child and my child’s original work for any other lawful purpose whatsoever, including video, audio, photographic portraits, pictures, reproductions, quotations, made through any medium, including social or other electronic media, in accordance with the Safe Environment Social Communication Policy for the Diocese of Green Bay.
  https://www.gbdioc.org/protecting-our-children/safe-environment
  
  This statement of intent, and if indicated – consent, is valid for one year. If I choose to rescind my consent to the Authorization, I agree that I will inform Faith Formation in writing and that my rescission will not take effect until it is received by Faith formation. I understand however, that it may not be possible to recall any worker photos that have been published prior to receipt of my written rescission.
  
  As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("participant"). I agree on behalf of myself, my child name therein, or our heirs, successors, and assigns, to hold harmless and defend Faith Formation / Youth Ministry its officers, directors, employees and Faith Formation / Youth Ministry agents, and the Diocese of Green Bay, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending therewith, and I agree to compensate the parish/school, its officers, directors and agents, and Diocese of Green Bay its employees and agents and chaperones, or representative associated with the event for reasonable attorney's fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school or the Diocese of Green Bay.
  
  Media Release - I authorize and consent. Yes No
  
  Minor Name 3
  
  Communication electronically, via email, text, social media or other digital means, in accordance with the Safe Environment Social Communication Policy for the Diocese of Green Bay by parish, catechists, youth leaders.
  https://www.gbdioc.org/protecting-our-children/safe-environment
  
  I give permission to digitally communicate with my child. Yes No
  
  Authorize and consent that Faith Formation Program, the Diocese of Green Bay and anyone authorized by Faith Formation or Diocese of Green Bay be permitted to use and publish for general communication, advertising, commercial and publicity purposes, the likeness of my child and my child’s original work for any other lawful purpose whatsoever, including video, audio, photographic portraits, pictures, reproductions, quotations, made through any medium, including social or other electronic media, in accordance with the Safe Environment Social Communication Policy for the Diocese of Green Bay.
  https://www.gbdioc.org/protecting-our-children/safe-environment
  
  Media Release - I authorize and consent. Yes No
  
  This statement of intent, and if indicated – consent, is valid for one year. If I choose to rescind my consent to the Authorization, I agree that I will inform Faith Formation in writing and that my rescission will not take effect until it is received by Faith formation. I understand however, that it may not be possible to recall any worker photos that have been published prior to receipt of my written rescission.
  
  As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("participant"). I agree on behalf of myself, my child name therein, or our heirs, successors, and assigns, to hold harmless and defend Faith Formation / Youth Ministry its officers, directors, employees and Faith Formation / Youth Ministry agents, and the Diocese of Green Bay, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending therewith, and I agree to compensate the parish/school, its officers, directors and agents, and Diocese of Green Bay its employees and agents and chaperones, or representative associated with the event for reasonable attorney's fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school or the Diocese of Green Bay.
  
  Minor Name 4
  
  Communication electronically, via email, text, social media or other digital means, in accordance with the Safe Environment Social Communication Policy for the Diocese of Green Bay by parish, catechists, youth leaders.
  https://www.gbdioc.org/protecting-our-children/safe-environment
  
  I give permission to digitally communicate with my child. Yes No
  
  Authorize and consent that Faith Formation Program, the Diocese of Green Bay and anyone authorized by Faith Formation or Diocese of Green Bay be permitted to use and publish for general communication, advertising, commercial and publicity purposes, the likeness of my child and my child’s original work for any other lawful purpose whatsoever, including video, audio, photographic portraits, pictures, reproductions, quotations, made through any medium, including social or other electronic media, in accordance with the Safe Environment Social Communication Policy for the Diocese of Green Bay.
  https://www.gbdioc.org/protecting-our-children/safe-environment
  
  Media Release - I authorize and consent. Yes No
  
  This statement of intent, and if indicated – consent, is valid for one year. If I choose to rescind my consent to the Authorization, I agree that I will inform Faith Formation in writing and that my rescission will not take effect until it is received by Faith formation. I understand however, that it may not be possible to recall any worker photos that have been published prior to receipt of my written rescission.
  
  As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("participant"). I agree on behalf of myself, my child name therein, or our heirs, successors, and assigns, to hold harmless and defend Faith Formation / Youth Ministry its officers, directors, employees and Faith Formation / Youth Ministry agents, and the Diocese of Green Bay, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending therewith, and I agree to compensate the parish/school, its officers, directors and agents, and Diocese of Green Bay its employees and agents and chaperones, or representative associated with the event for reasonable attorney's fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school or the Diocese of Green Bay.
  
  Parent / Guardian Signature
  (this constitutes the signed and agreed upon statements above)
  
  Submit
  
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