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Monday Session

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  CHILD'S FIRST NAME REQUIRED Maximum 100 characters Please fill out this field. Please enter valid data.
  
  CHILD'S LAST NAME REQUIRED Maximum 100 characters Please fill out this field. Please enter valid data.
  
  CHILD'S DATE OF BIRTH REQUIRED Please fill out this field. Please enter valid data.
  
  GRADE (in September 2021) REQUIRED Maximum 10 characters Please fill out this field. Please enter valid data.
  
  REGISTERED MEMBER OF OUR LADY OF MERCY REQUIRED YES NO Please fill out this field.
  
  If no, please CLICK HERE if you would like to register your family at Our Lady of Mercy.
  
  PARENT 1 (or Guardian) REQUIRED Maximum 100 characters Please fill out this field. Please enter valid data.
  
  RELIGION (Parent 1) REQUIRED Maximum 50 characters Please fill out this field. Please enter valid data.
  
  Parent 2 (or Guardian) Maximum 50 characters Please enter valid data.
  
  RELIGION (Parent 2) Maximum 50 characters Please enter valid data.
  
  ADDRESS Maximum 100 characters Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
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  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  SACRAMENTS
  My child has received the following:
  
  CHURCH OF BAPTISM REQUIRED Maximum 100 characters Please fill out this field. Please enter valid data.
  
  CHURCH OF RECONCILIATION REQUIRED Maximum 100 characters Please fill out this field. Please enter valid data.
  
  CHURCH OF FIRST HOLY COMMUNION REQUIRED Maximum 100 characters Please fill out this field. Please enter valid data.
  
  EMERGENCY
  If Parent is not available in an emergency, contact:
  
  NAME REQUIRED Maximum 75 characters Please fill out this field. Please enter valid data.
  
  RELATIONSHIP REQUIRED Maximum 50 characters Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  IS THERE ANY OTHER INFORMATION WE SHOULD KNOW IN ORDER TO MORE EFFECTIVELY MINISTER TO YOUR CHILD?
  
  DOES YOUR CHILD HAVE ANY ALLERGIES?
  
  DOES YOUR CHILD REQUIRE MEDICATION OR AN EPI-PEN? REQUIRED Yes No Please fill out this field.
  
  IF YES, WHAT AND WHEN ADMINISTERED?
  
  Can you volunteer?
  Please support our positive efforts by sharing your blessings of time an talent!
  Greeters
  For the Junior Hith program, it is essential to have greeters at the door. Greeters welcome the teens at the door and watch the parking lot/bathrooms for any disturbances. It is important for teens an parents alike to know that Junior High participants are coming to a safe, welcoming environment. Greeters help to create this atmosphere.
  
  Group Leaders and Assistants
  At each session, we spend 30 minutes in small groups discussing the large group activity and the topic or the day. We need nurturing, faith-filled adults to encourage healthy, productive discussion with our teens. We also need adults to assist the main group leader or fill in for an absent adult. Very little preparation is needed. In the spirit of stewardship, group leaders and assistants pay only $25 for use of the book.
  
  I WOULD LIKE TO HELP OUT BY BEING: Group Leader Group Assistant
  
  Please be aware that ALL volunteers must have Protecting God's Children certification.
  
  Please Fill Out a "CODE OF CONDUCT" Form Found on the Junior High Web Page
  
  PERMISSION FROM PARENT / GARDIAN REQUIRED I hereby give my permission for my child to attend Junior High Youth Group at Our Lady of Mercy Church. Please fill out this field.
  
  Photo Release Permission Slip
  As a parent or guardian of this student, I hereby consent to the use of photographs/video taken during the program for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
  
  PLEASE SELECT ONE REQUIRED Yes, I give consent for Our Lady of Mercy to photograph/video my child during the program and/or events for public relations purposes. No, I do not authorize Our Lady of Mercy to photograph/video my child during the program and/or events. Please fill out this field.
  
  PLEASE NOTE: This fee is separate from the K-6 Religious Education program.
  
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