Old Mission San Juan Bautista Religious Education Registration Form Office Phone: (831)

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María Rosa Aranda Botella
hace 7 años
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1 Old Mission San Juan Bautista Religious Education Registration Form Office Phone: (831) Today's Date: Amount Paid: Installments: RCIA: 1st Yr [ ] 2nd Yr [ ] 1st Communion: 1st Yr [ ] 2nd Yr [ ] Confirmation: 1st Yr [ ] 2nd Yr [ ] Birth Certificate [ ] Baptism Certificate [ ] Baptism/1st Comm. Certificate [ ] Family Name / Apellido Children's Names / Nombre de Estudiantes e mail address / enviar electronica: Parent/Guardian/Nombre de Padre Information: Father/Padre [ ] Guardian/Custodio [ ] Last Name/Apellido First Name/Nombre Religion (optional) Phone/Telefono Address / Physical Address Domicilio / Apartado Postal Parent/Guardian/Pariente/Custodio: Mother/Madre [ ] Guardian/Custodio [ ] Last Name/Apellido First Name/Nombre Religion (optional) Phone/Telefono Mailing Address ONLY if parents / guardians have seperate addresses / include physical address when address is a P.O. Box. Emergency information ONLY if different from Parent /Guardian Information above: Informacion de presona solamente si los parientes no pueden responder en una emergencia: Person to Call/ Contacto Phone / Numero Names/Phone numbers of individuals who are permitted to pick up child: 1

2 Nombre y telefono de personas que usted confia llevarse sus ninos Name/Nombre Phone/Telefono Name/Nombre Phone/Telefono Name/Nombre Phone/Telefono Name/Nombre Phone/Telefono Children's Information: 1. Last Name/Apellido First Name/Nombre Grade/Grado Age/Edad Date of Birth/Fecha de Nacimiento Place of Birth/Donde Nacio Sacraments Received: Date / Church / Place of Baptism / Fecha de Bautismo/Iglesia de Bautismo Date / Church / Place of 1st Communion / Fecha de Primera Comunion/Iglesia de Comunion Date / Church / Place of Confirmation / Fecha de Confirmacion 2. Last Name/Apellido First Name/Nombre Grade/Grado Age/Edad Date of Birth/Fecha de Nacimiento Place of Birth/Donde Nacio Sacraments Received: 2

3 Date / Church / Place of Baptism / Fecha de Bautismo/Iglesia de Bautismo Date / Church / Place of 1st Communion / Fecha de Primera Comunion/Iglesia de Comunion Date / Church / Place of Confirmation / Fecha de Confirmacion 3. Last Name/Apellido First Name/Nombre Grade/Grado Age/Edad Date of Birth/Fecha de Nacimiento Place of Birth/Donde Nacio Sacraments Received: Date / Church / Place of Baptism / Fecha de Bautismo/Iglesia de Bautismo Date / Church / Place of 1st Communion / Fecha de Primera Comunion/Iglesia de Comunion Date / Church / Place of Confirmation / Fecha de Confirmacion Family Medical Information: Family Physician/Medico Phone/Numero Family Dentist/Dientista Phone/Numero Allergies/Alergias: [ ] YES/Si [ ] NO List of Allergies/Lista de Alergias: Is you child on Medications? [ ] YES [ ] NO List of Medicatons: 3

4 Other Special Needs/Otras Necesidades: Should it be necessary for my child to have medical treatment, I, Hereby give Old Mission San Juan Bautista Teaching Center Personnel permission to use their judgment in obtaining medical services for my child, and I give permission to the physician selected by the personnel to render medical treatment deemed necessary and appropriate. I agree that in the event my child or children, is or are injured as a result of his/her participating in the religious education program, recourse for the payment of any resulting hospital, medical or related costs and expenses will first be had against any accident, hospital or medical insurance, or any available benefit plan of mine or my spouse. Parent/Guardian Signature Date Si es necesario parami nino recibir tratamiento medico, yo, Por estemedio da a Mision San Juan Bautista Departa mento de educacion religios el permiso de Personal de usar su juicio en la obtencion de servicios medicos para mi nino, Y doy el permiso al medico seleccionado por el personal para dar medico el tratamiento juzgo necesario y apropiado. Estoy de acuerdo que tal como resulto despues mi nino o ninos, son heridos a comsecuencia de su participación en el programa de educación religioso, recurso para el pago de cualquier hospital que resulta, medico o los gastos relacionados y los gastos serán primero cotra cualquier accidente, hospital o seguro medico, o cualquier plan de beneficios disponible mío o mi cónyuge. Firma Fecha Volunteer / Donations for Religious Education Program: 4

5 Please check one of the following areas where you are interested in helping us. [ ] Contribution to our Scholarship Fund [ ] Catechist for 1st through 5th grade (Wednesday afternoons 2:00 pm 3:30 pm) [ ] Catechist for 6th through 9th grades (Thursday, twice a month 7:00 pm 8:30 pm) [ ] Be a helper for Catechist Wednesday afternoons, or Thursday evenings [ ] Fundraisers for 1st and 2nd Year : Parking Cars [ ] *************************************************************************************************** ****THIS SPACE IS FOR OFFICE USE ONLY**** Please make checks payable to: Old Mission San Juan Bautista Registration Fees One Child Two Children Three Children $45 : $60 : $70 : Retreat Fees First Eucharist Retreat Fee 1st Yr Confirmation Retreat Fee $20 : $20 : 2nd Yr Confirmation Retreat Fee $50 : St Francis Retreat Center Total Due: Amt Paid: Cash: Check# Installments: Baptism Certificate: [ ] Received Not received: [ ] Date rec'd: 5

6 RCIA: Birth Certificate: [ ] Received Not received: [ ] Date rec'd: Notes: 6

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