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Religious Education / Confirmation Registration 2017/2018

The Church with whom
you are registered
St Bridget
St Bartholomew     

Your Contact Information            
Name        Maiden:
Relationship to child Mother / female guardian
Father / male guardian     
Primary Phone No.      Home     Cell     Work      
Other Phones      Home     Cell     Work   
       Home     Cell     Work   
Street Address   
City State Zip         

Spouse / Partner            
Name         Maiden:
Primary Phone No.    Home     Cell     Work      
Other Phones    Home     Cell     Work   
     Home     Cell     Work   
  If address is same as above, check here and leave this address blank.
Street Address
City State Zip

Best Emergency Contact     Mother     Father       
Who should we contact in an emergency if we are unable to reach a parent or guardian at the above numbers?
Other Emergency Contact
Primary Phone No.    Home     Cell     Work   
Other Phones    Home     Cell     Work   
     Home     Cell     Work   

Children reside with: Both Parents     Mother     Father     Guardian   

Children (all information pertains to the 2017/2018 school year)
Sunday - grades Pre-K thru 6 (8:30-9:45 AM)
Tuesday      - grades K thru 5 (3:45-5:00 PM)
Wednesday - grades K thru 5 (3:45-5:00 PM)

Monday - grades 6 thru 8 (6:45-8:00 PM)
Sunday - grades 9-12 (6:30-8:30 PM) monthly
First NameLast NameSexGradeDay/TimeSchoolRec'd First

Is this the first time that you have enrolled children in St Bridget or St Bartholomew Religious Education program? Yes No   
Last completed year of Religious Education (anywhere, including St Bridget or St Bartholomew):
Grade: Parish: City: State:

Emergency Medical Treatment

In the event of an emergency, I hereby give permission to transport my children to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
Family Doctor Phone
Family Health Carrier Policy No.
Any special emotional or medical problems or learning disabilities of which we should be aware?    Yes    No   
I hereby warrant that to the best of my knowledge, my children are in good health, and I assume all responsibility for the health of my children.

Pre-K thru 8:   $85 per child with a family maximum of $255.  
Grades 9-12:   $160 per child   (no maximum)  
Catechists (teachers) pay no fees. Discuss with Denise or Steve.
Payment Method: Online       Check       I will be a Catechist (teacher)
It is not necessary to create an account to use Online Giving; just use the "Quick Give" link at the Online Giving page.

No child will be denied Religious Education.  If there are financial issues, please call (860)646-1613 and talk to
Denise (pre-K thru 8)  -  extension 105, or
Steve (high school)  -  extension 107.

Photo/Video Release
I grant permission for my children to be photographed/videotaped during Religious Education/Confirmation/Youth Ministry activities. I realize the photo/video may be published in the newspaper, the parish website or other publication.
Yes     No    

Electronic Signature (parent or guardian):
   I am a parent or legal guardian of the children named above. I have examined all the information on the form and it is true and correct to the best of my knowledge. I understand and agree that my registration will be signed electronically when I enter my name above and select the check box.   

Saturday December 16, 2017