Sunday School Registration Form (2012-2013)
Operated by St. Paul Chong Korean Catholic Center in Tri-Valley
Class starting on Sep. 9(Sun) 9am
Registration Fee incl. PTA fee ($70 for 1 student, $140 for 2 students, max $180/family)
Student-1
Student-1 Full Name
*
English
Baptismal Name
Korean
Sex(M or F)
Student-1 Grade
*
Please Select
Kinder
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Sacrament received
*
Baptism
1st Communion
Confirmation
None
Student-2
Student-2 Full Name
English
Baptismal Name
Korean
Sex(M or F)
Student-2 Grade
Please Select
Kinder
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Sacrament received
Baptism
1st Communion
Confirmation
None
Student-3
Student-3 Full Name
English
Baptismal Name
Korean
Sex(M or F)
Student-3 Grade
Please Select
Kinder
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Sacrament received
Baptism
1st Communion
Confirmation
None
Parents Information
Parent-1 Full Name
*
English
Baptismal Name
Korean
Sex(M or F)
Parent-1 Phone
*
Parent-1 E-mail
*
Parent-2 Full Name
*
English
Baptismal Name
Korean
Sex(M or F)
Parent-2 Phone
Parent-2 E-mail
Home Address
*
City, Zip
Emergency Contact
*
Name
Phone
Name
Phone
Medical Insurer
*
Special Note (Allergy...etc.)
I hold the pastoral center and diocese of Oakland harmless from any claim of injury, sickness, illness or damage that my child may suffer or sustain during the Sunday school activities, with exception to injury of damages arising out of the sole negligence of the pastoral center or diocese of Oakland. I attest that my child is physically fit to participate in the Sunday school activities. In the event my child becomes ill or injured, I do hereby consent to whatever X-ray, examination, medical or treatment and hospital care are considered necessary in the best judgment of the attending physician and performed by or under the supervision of a member of the medical staff of the hospital facility provided the treatment. I am not aware of any medical condition which would render it inappropriate for my child to participate in any such activity.
Waiver Authorization
*
Agree
From time to time, we take pictures and video of youth ministry events and gatherings. We would like to be able to use these photographs and videos for flyers, parish and diocesan publications, and the ministry website. To do this, we need both students and the parents consent We will not use the last names of any individual whose photos or videos are posted if there are concerns about pictures or video posted on the website, please contact the youth ministry coordinator or webmaster, and they will promptly be removed. I/We, that parent(s) of this youth , authorize and give full consent, without limitation or reservation, to TVKCC to publish any photographs or videos in which the above named student and /or pictures or videos of his/her parents or videos of grandparent(s) appears while participating in any program with TVKCC ministry. There will be no compensation for use of any photographs at the time of publication or in the future.
Photograph and Video Consent
*
Agree
Submit
Should be Empty: