St. Peter Catholic Church
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2020-2021 Religious Education Registration Form
Family Information/Religious Instruction Request
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Indicates required field
Choose One
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Option 1
Option 2
In person Instruction
Online/Virtual Instruction
Last Name
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Home Phone Number
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Are you registered in the parish?
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Yes
No
Address
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City
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Untitled
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State
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Zipcode
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Father/Guardian
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Father's Cell Phone
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Father's Email Address
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Mother/Guardian
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I / We can help:
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Please Select One
Teach/Co-Teach
Aide
Mother's Cell Phone
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Mother's Email Address
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Student Information - Child 1
Child's Name: First, Middle, Last
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Entering Grade
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Gender
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Male
Female
Date of Birth
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City & State of Birth
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Indicate Sacraments already received:
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Baptism
Reconciliation
Communion
Allergies, Special Needs or Medical Conditions:
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Student Information - Child 2
Child's Name: First, Middle, Last
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Entering Grade
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Gender
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Male
Female
Date of Birth
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City & State of Birth
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Indicate Sacraments already received:
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Baptism
Reconciliation
Communion
Allergies, Special Needs or Medical Conditions:
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Student Information - Child 3
Child's Name: First, Middle, Last
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Entering Grade
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Gender
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Male
Female
Date of Birth
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City & State of Birth
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Indicate Sacraments already received:
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Baptism
Reconciliation
Communion
Allergies, Special Needs or Medical Conditions:
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If you are registering more than 3 children, complete and submit this form.
Please then visit the Religious Education Program page and select the option to register additional children.
Emergency Information
If my child becomes ill or is injured while attending Religious Education classes, please call:
Name
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Relationship to Student
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Phone Number
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Name
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Relationship to Student
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Phone Number
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I authorize the staff of Saint Peter to seek emergency medical care for my child as deemed appropriate.
Our Doctor preference is:
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Phone Number
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Our Dentist preference is:
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Phone Number
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Our Hospital preference is:
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Phone Number
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Please enter your full name to confirm your consent
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Date
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Diocesan COVID-19 Acknowledgement
The Harrisburg Diocese requires your acknowledgement that you have read and agreed to,
the conditions stated. Please indicate your consent after reading the document.
COVID-19 ACKNOWLEDGEMENT / NOTICE FOR PARISH RELIGIOUS EDUCATION/CCD
By signing or electronically accepting this COVID-19 Acknowledgement, the undersigned parent or guardian of a student enrolled in a Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YM) in the Diocese of Harrisburg, understands, acknowledges, and agrees as follows:
We live in the age of the COVID-19 global pandemic, and there are health risks associated with my child attending a Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YM). I acknowledge the contagious nature of COVID-19, the fact that it can be difficult to identify in another person, and the inherent risks of exposure to those who may be infected with COVID-19. I voluntarily assume the risk that I/my child/my household members may be exposed to or infected by COVID-19 as a result of or in connection with my child(ren)’s attendance at the Parish Religious Education Program
(PREP/CCD) and/or Parish Youth Ministry Program (YMP) and that such exposure or infection may result in illness and/or even death of my child(ren) and such other persons.
I have read the Health and Safety Plan located on my child(ren)’s parish website and understand the health and safety protocols of the Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YMP) and I agree to adhere to the health and safety protocols. I will partner with the parish and comply with the Health and Safety Plan. As further detailed in the Health and Safety Plan:
(i) I will update my child(ren)’s emergency contact information prior to or at the start of the Parish Religious Education (PREP/CCD) and/or Parish Youth Ministry (YMP) year and I will update it promptly whenever there is a change;
(ii) I will seek to limit my child(ren)’s exposure to COVID-19 outside of the Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YMP) in order to protect our entire Parish Religious Education and/or Youth Ministry community;
(iii) I will evaluate my child(ren) before each Parish Religious Education Program
(PREP/CCD) session and/or Parish Youth Ministry Program session for fever
and COVID-19 symptoms, as defined by the CDC, and I must check in through the Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program’s established system before each session;
(iv) If my child has a fever of 100.4 degrees F or higher, or COVID-19 symptoms as defined by the CDC, s/he may not attend the Parish Religious Education Program (PREP/CCD) session or Parish Youth Ministry Program (YMP) session;
(v) I will inform the Parish Religious Education Program (PREP/CCD) or Parish Youth Ministry Program immediately if I, my child, or anyone with whom my child has had close contact receives a positive diagnosis, or presumed positive diagnosis, for COVID-19;
(vi) I give my permission for the Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YMP) staff to evaluate my child(ren) for fever and COVID-19, at their discretion, and will be informed by the Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YMP) when such an evaluation is done;
(vii) If contacted, I will pick up my child promptly from the Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YMP) if the Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YMP) deems it necessary for health and safety reasons.
I understand and acknowledge that ill students are required to adhere to all guidelines of the Health and Safety Plan, and that willful violations of the Health and Safety Plan will result in disciplinary action up to and including expulsion from the Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YMP), at the Pastor’s/Parish Administrator’s discretion.
I understand and acknowledge that the Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YMP) will use its best efforts to guard my child(ren)’s privacy. I also understand and acknowledge that, as part of contact tracing, the name of my child(ren) and pertinent contact information will be provided, if necessary, to the Pennsylvania Board of Health and related authorities in the name of community health and safety.
I understand and acknowledge that my child(ren)’s Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YMP) may offer a distance/online learning option as part of the educational program.
I understand and acknowledge that distance/online instruction is part of the current educational landscape and, as such, classes/sessions may be recorded and that, on occasion, my child’s image could be seen or voice could be heard briefly as part of the class/session. Those who will have permission to access the recording are permitted to do so strictly for educational purposes.
I understand and acknowledge that I am not allowed to video or take photographs of distance/online instruction at my Parish Religious Education Program (PREP/CCD) and/or Parish Youth Ministry Program (YMP) unless it is for purely educational purposes, and I understand and acknowledge that that video or image may not be shared on social media or for any purposes other than educational purposes for my child(ren).
*** Consent is required to attend any Religious Education event.***
COVID-19 Consent
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Yes, I consent
No, I do not consent
Photo/Video Release
Parents/guardians of participants are advised that photograph or videotape of participants may be used in publications,
websites or other materials produced from time to time by Saint Peter Church, the Offices of Religious Education and Youth
Ministry or the Diocese of Harrisburg. Parents/guardians who do not wish their children be filmed or photographed should
notify the Office in writing. Please note that the Office has no control over the use of photographs or film taken by media that
may be covering the event in which your children participate.
Please Select One
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Yes, I consent
No, I do not consent
Please enter your full name to confirm your consent
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Date
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Tuition Rates for Religious Education
Paying tuition ON or BEFORE 10/09/2020(Please select all that apply)
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First Child $55.00
Second Child $50.00
Third Child $45.00
Fourth Child $40.00
Fifth Child $0.00 (Fee Waived)
Sacramental Fees – Students in Grades 2, 7 & 8 have a sacramental preparation fee of $25.00 per child.
How many children are registering in grades: 2, 7, 8?
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No Children
1 Child
2 Children
3 Children
4 Children
Submit Form
Home
From The Pastor
Online Masses
Parish Info
Welcome
Mass & Reconciliation
Sacramental Information
Register With Parish
Parish Team
Photo Gallery
Education
RCIA
Guardian Angel
Religious Education
>
RE Registration
Vacation Bible School
Catholic Education
SCRIP
Ministry
YOUTH MINISTRY
Ministry Schedule
CAMPUS MINISTRY
Parish Ministries
News
Parishioner News
DIOCESAN NEWS
Weekly Bulletin
Weekly Calendar
Monthly Look
Upcoming Events
St Peter Columbarium
Stewardship
Online Giving
Opportunities