2020-21 Faith Registration for Returning Families Form

Family Name:*
Mother's Name:*
Father's Name:*
Mother's Cell #:*
Father's Cell #:*
Home Address:*
Street Address Address Line 2 City State ZIP Code
Primary Phone:*
Primary Email:*
Secondary Email:
ALL REGISTRATIONS MUST BE RECEIVED BY SEPTMEBER 1ST, 2020 TO BE ADMITTED TO THE PROGRAM. REGISTRATIONS AFTER SEPTEMBER 1ST WILL BE CONSIDERED ON A CASE-BY-CASE BASIS. IF YOU HAVE AN OUTSTANDING TUITION BALANCE FROM A PREVIOUS YEAR AT THE TIME OF THIS REGISTRATION, IT MUST BE PAID IN FULL, OR YOU MUST MAKE ARRANGEMENTS WITH THE DIRECTOR BEFORE REGISTERING.
Student #1
Student First Name:*
Student Last Name:*
Student Middle Name:
Student Preferred Name:
Gender:*
Date of Birth:*
MM slash DD slash YYYY
Name of School:
2020-2021 Grade*
What would be helpful to know about your child? Allergies / Medical Conditions / Special Needs / Other:
Indicate Program Preferences:*
Comment / Requests (we cannot guarantee requests, but we do our best to accommodate them)
Will this child be preparing to receive a sacrament this year:
Student #2
Student First Name:
Student Last Name:
Student Middle Name:
Student Preferred Name:
Gender:
Date of Birth:
MM slash DD slash YYYY
Name of School:
2020-2021 Grade
What would be helpful to know about your child? Allergies / Medical Conditions / Special Needs / Other:
Indicate Program Preferences:
Comment / Requests (we cannot guarantee requests, but we do our best to accommodate them)
Will this child be preparing to receive a sacrament this year:
Student #3
Student First Name:
Student Last Name:
Student Middle Name:
Student Preferred Name:
Gender:
Date of Birth:
MM slash DD slash YYYY
Name of School:
2020-2021 Grade
What would be helpful to know about your child? Allergies / Medical Conditions / Special Needs / Other:
Indicate Program Preferences:
Comment / Requests (we cannot guarantee requests, but we do our best to accommodate them)
Will this child be preparing to receive a sacrament this year:
Student #4
Student First Name:
Student Last Name:
Student Middle Name:
Student Preferred Name:
Gender:
Date of Birth:
MM slash DD slash YYYY
Name of School:
2020-2021 Grade
What would be helpful to know about your child? Allergies / Medical Conditions / Special Needs / Other:
Indicate Program Preferences:
Comment / Requests (we cannot guarantee requests, but we do our best to accommodate them)
Will this child be preparing to receive a sacrament this year:
Emergency Contact #1
(other than parents)
Name*
Relation
Cell Phone*
Home Phone
Emergency Contact #2
(other than parents)
Name*
Relation
Cell Phone*
Home Phone
Physician Name*
Phone
Lots of help is needed to run our programs… how will you help this year?
Training and lesson plans are provided for catechists. We also offer a volunteer tuition discount. Contact Laura Ferlita at 847-907-3436 for more information.
Consent and Medical Release

I hereby release and indemnify Holy Family Parish, its staff and volunteers and the Catholic Bishop of Chicago, a corporation sole, from any and all liability arising from claims of any kind or nature whatsoever from my child’s participation in this year’s programs. In the event the undersigned or the noted physician cannot be reached, and in the judgment of a responsible person or appropriate staff member, there is a necessity for immediate examination and/or treatment of the registered child(ren), I hereby authorize, through my electronic signature below, any of the aforesaid personnel to obtain such medical service. In the signature box below, please provide your first and last name as authorization of the above.
Parent's/Guardian's Signature:*
Photography Release*
Holy Family staff/volunteers may photograph or videotape my child(ren) during Family and Teen Faith programs/activities to be used in Parish publications and media.
- Photograph My Child

PLEASE DO NOT LET COST BE A PROHIBITIVE FACTOR IN YOUR CHILD’S FAITH DEVELOPMENT.
Contact Courtney Smola at 847-907-3483 or csmola@holyfamilyparish.org to discuss payment plans (monthly payments) or financial assistance. All special requests for alternative payment plans must be received yearly by the first day of class.

TUITION AND FEES		Participating Rate	Non-Participating Rate
Adam’s Apple Program Fee:	1 child	$50 total
Pre-k and K	2+ children	$75 total
FAITH TUITION:	1 child	$325 total	$400 total
Grades 1 through Confirmation	2 children	$400 total	$475 total
Grades 1 through Confirmation	3 + children	$450 total	$525 total

SACRAMENTAL FEES:
RCIC	Per child	$75
First Eucharist Prep	Per child	$70
Confirmation Prep – (1st year – FLAME 1)	Per child	$125
Confirmation Prep -(2nd year – FLAME 2)	Per child	$40

Will you be paying the participating or non-participating rate*
In order to qualify for the Participating Rate, families must be registered parishioners, volunteer for a minimum of 5 hours, and financially contribute to the parish regularly online or through collection envelopes.
A $100 deposit is required to complete registration. You will receive an email in the next week with instructions on how to make your deposit online.

Your tuition balance is due in full by September 1st, 2020. Your child(ren) will not be placed in a class until your tuition has been paid in full or other arrangements have been made with the director.

Families withdrawing from the program must notify us no later than November 15, 2020 to qualify for a refund of any amount paid, less the $100 non-refundable deposit.

Student #1

Student #2

Student #3

Student #4

Emergency Contact #1

Emergency Contact #2

Consent and Medical Release

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