ST. JOHN THE EVANGELIST CATHOLIC CHURCH
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Parish School of Religion Registration Form

Dear Parents/Guardians,
​

Thank you for joining us for another year of faith formation. We are looking forward to another year of faith sharing, fun, and friendship! As you fill out the registration form please remember that any child who is new to the program and was baptized at a church other than St. John, must bring a copy of their baptismal record to the parish office. Please know that changes to your registration may be made any time before August 14, 2020.
ARCHDIOCESE OF CINCINNATI
PERMISSION, RELEASE AND
AUTHORIZATION TO SEEK MEDICAL TREATMENT (rev. 06-2020)
 
1. I, the parent or lawful guardian of __________ (the “Child”), give permission for my Child to participate in the activity described on the Activity Information form (the “Activity”) and release from all liability and indemnify St. John the Evangelist (“School”), the Archdiocese of Cincinnati (the “Archdiocese”), the Archbishop of Cincinnati (the “Archbishop”), both individually and as trustee for the Archdiocese, and all parishes and schools within the Archdiocese,  their respective officers, agents, representatives, volunteers, and employees, and all priest, bishops, clergy, and religious of the foregoing entities, from any and all liability, claims, judgments, damages, costs and expenses, including attorneys’ fees, arising out of any injury, death, illness, or infectious disease, such as MRSA, influenza, or COVID-19, (including any injury, death, illness, or infectious disease caused by the negligence of School, the Archbishop, the Archdiocese, any parish or school within the Archdiocese, and/or their respective officers, agents, representatives, volunteers or employees) incurred by my child while participating in or traveling to or from the Activity and further agree not to bring or prosecute or allow to be brought or prosecuted (including but not limited to prosecution through subrogation) in my name, or on behalf of my Child, any claims, lawsuits, or actions against School, the Archbishop, the Archdiocese, all parishes and schools within the Archdiocese, and their respective officers, agents, representatives, volunteers and employees.
 
2. I further understand that my Child’s participation in the Activity is purely voluntary and is a privilege and not a right, and that my Child, and I on behalf of my Child, agree to my Child’s participation in the Activity in spite of the risks.
 
3. I agree to instruct my Child to cooperate with the Archbishop or his agents in charge of the activity.
 
4. I appoint the Archbishop or his agents who are acting as leaders of the Activity to seek medical treatment of my Child in the event any injury, illness, infectious disease, or medical emergency occurs during the Activity or related travel.  I understand that the agents of the Archbishop will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my Child.
 
5. I agree that the Archbishop or his agents may use my Child’s portrait or photograph for promotional purposes, website, and office functions and use social media and technology to communicate to my Child regarding ministry related activities.
 
6. This acknowledgement and release is intended to be as broad and inclusive as permitted by the law of the State of Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.  This acknowledgement and release shall be construed in accordance with the laws of the State of Ohio, except for the choice of law provisions thereof.
 
7. School, the Archdiocese, the Archbishop and their agents, employees, and volunteers shall have no liability whatsoever in the event the Activity is cancelled due, in whole or in part, to any present or future pandemic, epidemic, widespread disease or illness, public health concern, or circumstances arising therefrom, or from actions taken by any governmental or municipal authority to prevent, avoid, or mitigate the impacts thereof, irrespective of whether formally declared as a “pandemic”, “epidemic”, or the like by any public health entity or governing body.  
 
I have carefully read and understand and accept the terms and conditions stated herein and acknowledge that this Permission, Release and Authorization to Seek Medical Treatment shall be effective and binding upon me, my Child, and my own and my Child’s personal representative or estate, assigns, heirs, and next of kin and that I have signed this agreement of my own free will.

    Parish School of Religion Registration Form

    school attended by student for 2014-2015 school year

    home address of student
    best phone number(s) to contact parent(s)
    primary family email address

    *Regular, weekly volunteers for Catechist, Assistant Catechist, and Office Assistant, tuition will be waived for all children in your household that in are PSR (Pre-K through 8th grade)!

    please read the medical statement above before denoting your agreement
    place of employment for one or both parents
    work phone number(s) for parent(s)
    full work address(es) for working parent(s)
    name/relationship/phone # of non-parent emergency contact
    any medications the child is taking that would need to be known in an emergency situation
    e.g. seizures, diabetes, peanut allergy, other conditions
    name of insurance company covering the child
    policy and group numbers on child's insurance card
    name of the parent/guardian covering the child with insurance

    ​Generations of Faith is held two times per year for community and service. These parish/family gatherings will occur on two days in October and two days in February. Participation in Generations of Faith is required for all PSR families, whether classroom study or home study. 

    name of child's primary physician
    phone number for child's primary physician

    Please be sure to pay the fee (per child) by mailing it (for the Early Bird fee, envelope must be postmarked by July 31), dropping it in the collection basket, or bringing it into the parish office by the deadline.

    ​*If you chose to pay online, please follow this link: https://stjohnwc.weshareonline.org/#. You can also find this link on the homepage (the "Donate or Make a Payment" button).

    Don't forget to click submit!
    please choose your payment method

Submit
We Are the Body of Christ
Parish Theme

9080 CINCINNATI-DAYTON RD 
WEST CHESTER, OH 45069-3129 
PARISH OFFICE: (513) 777-6433
  • Home
  • About
    • Contact Us
    • Events
    • Job Openings
    • Pandemic Portal
    • Parish Forms
  • Organizations
    • Boy Scouts
    • Girl Scouts
    • Knights of Columbus
    • Society of St. Vincent de Paul
    • Worship Commission
  • Ministries
    • Bereavement
    • Healing Touch
    • Justice and Peace
    • Liturgical Ministers
    • Liturgy of the Word With Children
    • Ministry to Returning Catholics
    • Music Ministry
    • Outreach and Support
    • SAL
    • Spirited Seniors
    • Youth Ministry
  • Faith Formation
    • Adult Faith Formation >
      • Bible and Book Studies
      • Missions & Retreats
      • RCIA
      • Small Church Communities
      • Speakers & Workshops
      • Theology on Tap
    • Children's Faith Formation
    • Sacraments >
      • Anointing of the Sick
      • Baptism
      • Marriage
  • Media
    • Bulletins
    • E-Memo
    • On Eagle's Wings
    • Watch Online