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  Religious Education Registration Form
  
  Please fill out and submit for each individual child
  
  Family Information
  
  Mother's Information
  
  Mother's Full (Maiden) Name Please enter valid data.
  
  Mailing Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Mother's Religion
  
  Father's Information
  
  Father's Full Name Please enter valid data.
  
  Mailing Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Father's Religion
  
  Household
  
  Parents Marital Status REQUIRED Please fill out this field.
  
  Siblings
  
  Is your family registered in the Parish of the Resurrection of the Lord? REQUIRED Yes No Please fill out this field.
  
  Primary Responsible Party:
  
  The "primary responsible party" is the parent or guardian with whom the parish should expect to do all/most correspondence.
  
  Full (Maiden) Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Child REQUIRED Please fill out this field.
  
  Please fill out if different from above:
  
  Mailing Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Religion
  
  Emergency Contact (Primary)
  
  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 Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Relation to Child REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  Emergency Contact (Secondary)
  
  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 Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Relation to Child REQUIRED Please fill out this field.
  
  If other, please specify: Please enter valid data.
  
  Student Information
  
  Child's Personal Information:
  
  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 of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Physical Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Mailing Address (if different from above) Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Grade in School REQUIRED Please fill out this field.
  
  School Type REQUIRED Please fill out this field.
  
  Allergens? Milk Eggs Fish Shellfish Tree Nuts Peanuts Wheat Soybeans Sesame Other
  
  If other, please specify:
  
  Other medical concerns:
  
  Other important information we should know:
  
  Child's Sacramental Information:
  
  Has your child been baptized? REQUIRED Yes No Please fill out this field.
  
  Baptism Denomination
  
  Church of Baptism Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Has your child been confirmed? REQUIRED Yes No Please fill out this field.
  
  Church of Confirmation Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Has your child received First Holy Communion? REQUIRED Yes No Please fill out this field.
  
  Church of First Communion Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Releases
  
  It is the policy of the Diocese of Portland, ME that minors are to be released from our supervision only to parents, legal guardians, and emergency contacts. Exceptions are made only to those explicitly approved by a parent or legal guardian. If you wish to grant authorization for another adult to pick up your child, please specify below. Names can be added or revoked in writing only.
  
  Adult #1
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relation to Child: Please enter valid data.
  
  Adult #2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relation to Child: Please enter valid data.
  
  Adult #3
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Relation to Child: Please enter valid data.
  
  Safe Environment Training
  
  Circle of Grace is part of the Safe Environment Training program of the Diocese of Portland. It is a curriculum that offers different lessons for each grade level. If your children attended Circle of Grace in the past, we still invite them to attend as it is likely to be a different lesson.
  
  Do you give permission for your child to attend Circle of Grace as part of the regular Faith Formation program? REQUIRED Yes No Please fill out this field.
  
  If you selected "no," please print out and sign the Parent Opt-Out Form and return to Jessica Moore.
  
  Image Release and Permission to Participate in Virtual Learning and Formation Settings
  
  There are times when we would like to share good things happening in the parish. To do this, we need parental permission to publish or publicaly display photographs, videos, or other media with images of minors. This includes print and digital formats used by the parish such as bulletins, newsletters, websites, Facebook, or Instagram. While the grade level or group of children depicted may be provided, additional parental permission will be secured before using full names to identify specific children in an image or recording.
  
  There are other times when we would like to offer learning and faith formation activities in virtual settings such as videoconferences and interactive social media platforms. Parent and students will receive specific invitations for any virtual gatherings and all sessions will be recorded for later review.
  
  I give my permission to display or publish images of my child as described above and for my child to participate in virtual learning and faith formation settings provided as part of parish programming. REQUIRED Yes No Please fill out this field.
  
  Volunteering
  
  A good Religious Education Program is dependent upon active and engaged parents. There are many different opportunities for volunteering and service, and we would like to invite you to join us!
  
  (Note: All volunteers are expected to comply with Diocesan Safeguarding Standards and, depending on the particular ministry in which they wish to engage, will be asked to participate in Protecting God's Children and ongoing Virtus training. More information will be given at the time of contact.)
  
  Are you interested in being contacted about volunteering in our Religious Education Program? REQUIRED Yes No Please fill out this field.
  
  If yes, what areas interest you? (click all that apply) REQUIRED Classroom Teacher Classroom Aide Kitchen work (snacks and meal prep) Snack / food donations Event planning Riverfest Trunk or Treat Christmas Play Anywhere I might be needed! Please fill out this field.
  
  In submitting this form, I (primary responsible party for the abovementioned child) attest that the information herein is accurate. I give my permission for the Parish of the Resurrection of the Lord and the Diocese of Portland, ME to keep and to refer to this information, but not to share it with any other party. I further give my consent for the Parish of the Resurrection of the Lord to contact me by phone, email, mail, and/or other modes of communication.
  
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The Parish of the Resurrection of the Lord

Old Town - Orono - Bradley - Penobscot Nation