2019-20 RE Registration Form – St. Emily Catholic Church

1 Contact Info

2 Photo/Video Release

3 Tuition

4 Student Info

5 Medical Authorization

6 Volunteer Form

This form is for. . .*
- St. Emily Parish
- St. Thomas Becket Parish
ST. EMILY PARISH
1400 E. Central Road, Mt. Prospect, IL 60056
Phone: 847-299-5865 Fax: 847-544-5035
ST. THOMAS BECKET PARISH
1321 Burning Bush Lane, Mt. Prospect, IL 60056
Phone: 847-296-9051
First Parent's/Guardian's Name:*
First Last
Cell Phone:*
First Parent's/Guardian's Email Address:*
Relationship*
Address:*
Street Address Address Line 2 City State ZIP Code
Second Parent's/Guardian's Name:
First Last
Relationship
Cell Phone:
Second Parent's/Guardian's Email Address:
Address:
Street Address Address Line 2 City State ZIP Code
Child(ren) reside(s) with:*
- Both parents
- Mother
- Father
- Legal Guardian
Absence Policy*
- By checking this box, I acknowledge the policy of the St. Emily / St. Thomas Becket Religious Education program that states that more than three absences per year are excessive. I further acknowledge that leaving early or coming late for extracurricular activities is not acceptable.
If your child is already committed to an activity that will make coming to class on Wednesday evenings difficult, we are happy to work with you to explore options for home school (if it is available for this grade) or to help you find a Religious Education program that better fits your family schedule.

Photo and Video Release
From time to time, we like to post pictures of the students in the Religious Education program engaged in their activities. Our postings might include, but are not limited to, the school bulletin board, the Religious Education and parish Facebook pages, the Religious Education and parish websites, and email communications to families.

This release is effective September 1, 2019.
Please indicate the following:*
- I give permission for my child(ren)'s photo, video, or academic work to be published in any format (i.e. website, announcements, print, social media) including group or individual photos.
- Please contact me for the specific occasion.
- I DO NOT give permission for my child(ren)'s photo, video or academic work to be published in any format (i.e. website, announcements, print, social media) including group or individual photos.

2019-20 Tuition
The tuition rate is the same for contributing parishioners of St. Emily or St. Thomas Becket.
For Parishioners:
- 1 student - $300
- 2 students - $425
- 3 or more students - $600
For Non Parishioners:
- 1 student - $475
- 2 students - $600
- 3 or more students - $775
Sacramental Fees Please select the appropriate fee if your child(ren) is receiving a sacrament this school year.
Confirmation (payable in eighth grade)
- Religious Education Student - $75
First Reconciliation/First Communion (for second graders and any student celebrating the sacraments this year)
- St. Thomas Becket Religious Education Student - $50
- St. Emily Religious Education Student - $60 (includes the cost of photos)
- St. Emily Parish - The preferred method of payment is through
  E-giving. Please see this guide for help with setting up your e-giving payments. You may also pay by cash or check in full or installments in the Religious Education office. Please contact Catherine Crino if you need to make other arrangements.
- St. Thomas Becket Parish - The preferred method of payment is through GiveCentral at
  GiveCentral. You may also pay by cash or check in full or installments in the Religious Education office. Please contact Renata Sosin if you need to make other arrangements.
With my signature, I acknowledge that it is my responsibility to pay tuition in full by April 30, 2020.

No child is denied Religious Education due to an inability to pay.
Signature*
Date*

Medical Information - Authorization for Medical Treatment
Terms and Conditions*
- In the event that the undersigned, or my (our) emergency contact cannot be reached and in the judgment of Catherine Crino, Renata Sosin or an authorized representative, or any other staff member of St. Emily Parish or St Thomas Becket Parish, there is a necessity for immediate examination and/or treatment of my (our) child, I (we) hereby authorize any of the aforesaid personnel to obtain for my (our) child such medical services as are deemed necessary.
  
  This release and authorization is valid for September 1, 2019 through August 31, 2020.
  
  By providing my electronic signature below, I agree to the aforementioned terms and conditions.
Signature*
Date*
Contact acknowledgement*
- I understand that the Emergency Contact can NOT be a parent or guardian of this / these child(ren).
Emergency Contact Person*
First Last
Emergency Contact Person Relationship*
Please list the relationship your emergency contact has to your child(ren)
Emergency Contact Person Phone*
Child's Name:*
First Last
Grade:*
Allergies, Medications, Significant Medical Conditions*
Last Tetanus Shot
Second Child's Name
First Last
Grade
Allergies, Medications, Significant Medical Conditions
Last Tetanus Shot
Third Child's Name
First Last
Grade
Allergies, Medications, Significant Medical Conditions
Last Tetanus Shot
Fourth Child's Name
First Last
Grade
Allergies, Medications, Significant Medical Conditions
Last Tetanus Shot

Religious Education Volunteer Form
Please check ANY or ALL areas of service that may be of interest to you. Someone from the Religious Education Office will contact you to answer all of your questions. We're glad to welcome you application as a volunteer. We'll be in touch with you regarding the requirements for the positon(s) you have selected.
- CATECHIST ($300 Volunteer Discount)
6:15PM session on Wednesdays.
Grade Level(s)
- ASST. CATECHIST ($300 Volunteer Discount)
6:15PM session on Wednesdays
Grade Level(s)
- SUBSTITUTE CATECHIST ($25 Volunteer Discount)
6:15PM session on Wednesdays
Grade Level(s)
- SESSION VOLUNTEER ($25 to $75 Volunteer Discount)
- VACATION BIBLE SCHOOL (July 22 - July 26, 2019) ($75 Volunteer Discount for the week.)
Event Volunteer
- Fish Fry in April
- Trunk Rummage Sale in May (tbd)
$25 - 75 discount applied to parent volunteers who help to organize and execute our fundraisers.
Phone
This field is for validation purposes and should be left unchanged.

St. Emily and St. Thomas Becket Parishes