Registration (CF Wednesdays)

Parent / Guardian #1 Contact Information

This is the primary contact for your child(ren) for the Catholic Formation Department.

Parent / Guardian #1 Name:

First

Last

Parent / Guardian #1 Email:

Parent / Guardian #1 Phone Number:

Parent / Guardian #1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact?

This person is the emergency contact

Parent / Guardian #2 Contact Information

Parent / Guardian #2 Name:

First

Last

Parent / Guardian #2 Email:

Parent / Guardian #2 Phone Number:

Parent / Guardian #2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact?

This person is the emergency contact

General Information

Your Primary Church:

Event Information (IC-Wednesdays)

Description of Event: Youth Catholic Formation
Date of Event: 9/15/25 – 5/15/26 Specific class dates are listed on the Youth Formation calendar.
Transportation Method: None
Participant cost: $80 per student
Sponsored by: Immaculate Conception Church & St. Patrick Church
Supervised by: Catholic Formation Team members and volunteers

Participant Registration Section

Please fill out the form below for each child that you are registering. To add another child, please click on the “Add Child” button at the bottom of the form for more child forms.

Child Registration

Child's Name:

First

Last

Date of Birth:

Gender:

Grade Level (In Fall):

Special Needs (Medical, Learning Disabilities, Physical Disabilities, etc.):

Do you need to submit a Medication Consent Form for this child?

Yes

If you selected “Yes”, you need to submit a Medication Consent Form. Please download the form here, fill out the form digitally and upload the completed form on the next page. Please include your child’s name within the saved form’s filename.

Participation Permission

I consent and give my permission

I give permission for my child to participate in the above named event. My signature below indicates that I understand the risks and hazards associated with this event, including injury, illness and the rare possibility of death. I understand that I may discuss any concerns or questions I have about this event with a representative of the parish or Diocese of Superior prior to giving permission for my child to participate.

In consideration for my child’s participation, I agree to reimburse and indemnify the above named parish and the Diocese of Superior for all reasonable legal and court fees incurred by the parish/diocese in defending a lawsuit that I or my child may bring against the parish/diocese which relates to the above named event if the parish/diocese is found not legally liable by the courts and prevails in the lawsuit. If the parish/diocese is found legally liable for any injuries sustained by my child, this paragraph will not apply. I further agree to reimburse the diocese or any other agency for property damage or any bodily harm to other participants caused by my child.

Child's Primary Physician

First

Last

Physician Phone Number:

Health System & Location

Health Insurance Carrier

Policy Number

Safe Environment Training Participation Permission

Yes, I would like my child to participate in the Safe Environment training described below.
No, I do not want my child to participate in the Safe Environment training described below

The Catholic Formation Department of Immaculate Conception Church & St. Patrick Church will be presenting Circle of Grace grade-level lessons to all children enrolled in Catholic Formation. This training is offered in response to the mandates of the United States Conference of Catholic Bishops Charter for the Protection of Children and Young People: Promise to Protect, Pledge to Heal. Circle of Grace was developed by the Archdiocese of Omaha and has been adopted by the Diocese of Superior as its curriculum to help keep our children safe. Parents and other caring adults want to protect children from those who might harm them, but no child can be supervised every moment of the day. This training will help your child recognize unhealthy relationships, appropriate ways to reduce the likelihood of being abused, and how to get help from others. Most importantly, this information will be presented to your child in a manner that reinforces his/her value as a person created in the image and likeness of God deserving of love and respect.

Your child’s training session will be held on 11/12/2025 at Immaculate Conception Church.

I understand that if I refuse to allow my child to participate in this training, I will receive a resource packet from the parish to help me educate my child on these important issues.

Signature

Clear Signature

Required Forms

Medication Form Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Photo, Video & Likeness Policy

Effective July 1, 2025, our policy for the use of photos, video recordings, and other likenesses at all church functions has gone into effect. Please view it here.

I acknowledge that I have read through all policies and filled out the appropriate information to register the children in this submission for ICSP Catholic Formation

Yes

Name of person acknowledging above:

Payment Section

The cost per registrant is $80 for the year with a family maximum of $200 per year.

Number of Children You Are Registering

Selected Value: 1

Registration Number: Level

Payment Type:

Total Cost for Registration:

Price is in Dollars (USD)

Name of Person Filling Out This Form:

Registration Submission

Your registration is incomplete until you click on the “Submit” button below, and you receive a confirmation on your screen.

SATURDAY	5:00 PM
SUNDAY	9:00 AM

TUESDAY	5:00 PM
WEDNESDAY	10:00 AM	8:15 AM Non-School Year
THURSDAY	8:15 AM
FRIDAY	8:15 AM

YOUTH FORMATION REGISTRATION

Parent / Guardian #1 Contact Information

Parent / Guardian #2 Contact Information

General Information

Event Information (IC-Wednesdays)

Participant Registration Section

Child Registration

Required Forms

Payment Section

Make your payment online:

Make your payment online:

Make your payment online:

Make your payment to the church office:

Registration Submission