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St. Mary's Assumption School
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St. Mary's Assumption
CAtholic church
Bronson, MI
Contact Us
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St. Charles Church
Our Lady of Fatima
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About Our Faith
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Religious Education
Confirmation Resources
Youth
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Mass & Confession Times
Liturgical Ministers Schedules
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St. Mary's Assumption School
RELIGIOUS EDUCATION
EDUCACIÓN RELIGIOSA
Formation
Alpha
The Wild Goose
Religious Education
Confirmation Resources
Youth
Adults
REGISTRATION FORM
FORMULARIO DE INSCRIPCIÓN
The maximum number of form submissions has been reached. This form is currently not available.
Instructions:
Fill out this form completely and accurately. Please, Do not use special symbols or contractions.
Instrucciones:
Favor de llenar esta forma por completo y de manera precisa. Por favor, no use acentos o contracciones.
FAMILY INFORMATION -
INFORMACIÓN FAMILIAR
Family Name - Apellido de la Familia
REQUIRED
Please fill out this field.
Please enter valid data.
Phone Number - Número Telefónico
REQUIRED
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Address - Dirección
REQUIRED
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City
REQUIRED
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State
REQUIRED
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Zip
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Email
REQUIRED
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Please enter an email address.
Father information - Información del Padre
First Name
REQUIRED
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Last Name
REQUIRED
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Cell Phone Number
REQUIRED
Maximum 20 characters
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Please enter a phone number.
Mother information - Información de la Madre
First Name
REQUIRED
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Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Cell Phone Number
REQUIRED
Maximum 20 characters
Please fill out this field.
Please enter a phone number.
Information of Children
Children
REQUIRED
Please fill out this field.
Child 1
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Middle Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Gender - Género REQUIRED
REQUIRED
(Select One)
Male
Female
Please fill out this field.
Sacraments already received - Sacramentos que ya recibió el niño(a)
REQUIRED
Baptism
First Confession / Reconciliation
First Holy Communion
Please fill out this field.
Date of Birth - Día de Nacimiento
REQUIRED
Please fill out this field.
Please enter valid data.
Grade for fall 2022 - Grado que cursará este otoño 2022
REQUIRED
(Select One)
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Please fill out this field.
MEDICAL CONDITIONS
List MEDICAL DIAGNOSIS or BEHAVIORAL CONDITIONS and MEDICATIONS TAKEN for any allergies, medical problems, behavioral issues, or other pertinent information. (e.g. Diabetes, Asthma, ADD, ADHD, Autism, Dyslexia, Seizure Disorder, Allergies, etc.)
MEDICAL INFORMATION AND MEDICAL RELEASE
Family Doctor / Medico Familiar
REQUIRED
Please fill out this field.
Please enter valid data.
Doctor's phone number/Número de teléfono
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Company
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Policy Number
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Group Number
REQUIRED
Please fill out this field.
Please enter valid data.
Name of Emergency Contact(s)/Nombre del contacto(s) de emergencia
REQUIRED
Please fill out this field.
Please enter valid data.
Phone Number of Emergency Contact(s) (cell, work, home)/Número de teléfono del contacto de emergencia (celular, trabajo, hogar)
REQUIRED
Please fill out this field.
Please enter valid data.
In the event of an emergency where medical treatment is required, I give my permission to the church staff or sponsor to obtain the services of a licensed physician. Please attempt to notify me immediately concerning any such emergency.
I Agree
Please select this field.
RELIGIOUS EDUCATION PARTICIPATION CONSENT FORM
If you would like your child to participate in this event, please select agree to the following statement of consent and release of liability.
As a parent or legal guardian, you remain fully responsible for the actions and conduct of your child.
"I hereby consent to participation by my child(ren), in St Mary's 2022 - 2023 Religious Education Program. I understand this event will take place within the three parish collaborative on the parish grounds of St Charles, Coldwater, Our Lady of Fatima, Union City and/or St Mary's Assumption, Bronson and my child(ren) will be under the supervision of the designated parish employee on the stated dates.
I further consent to the conditions stated above on participation in this event. In consideration of my child(ren) being allowed to participate in this event, I hereby agree on behalf of myself, and my child, to release the Parishes of St. Charles, Coldwater, Our Lady of Fatima, Union City and/or St. Mary's Assumption, Bronson, The Diocese of Kalamazoo and any and all affiliated organizations, their employees, agents, and representatives, including volunteers (collectively “Releasees”), from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. In the event this release on behalf of myself and/or my child(ren) is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releasees from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. This release of indemnification does not apply to the extent of commercial insurance coverage for any claim, but this Release of Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim."
I Agree
Please select this field.
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
PHOTO RELEASE FORM
St Mary's Assumption church Bronson, St Charles, Coldwater, and Our Lady of Fatima, Union City does not publish photos of recognizable persons without consent. If you agree with a recognizable image of your child to publish, please read this consent form, and click your agreement.
I Agree
Please select this field.
Child 2
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Middle Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Gender - Género REQUIRED
REQUIRED
(Select One)
Male
Female
Please fill out this field.
Sacraments already received - Sacramentos que ya recibió el niño(a)
REQUIRED
Baptism
First Confession / Reconciliation
First Holy Communion
Please fill out this field.
Date of Birth - Día de Nacimiento
REQUIRED
Please fill out this field.
Please enter valid data.
Grade for fall 2022 - Grado que cursará este otoño 2022
REQUIRED
(Select One)
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Please fill out this field.
MEDICAL CONDITIONS
List MEDICAL DIAGNOSIS or BEHAVIORAL CONDITIONS and MEDICATIONS TAKEN for any allergies, medical problems, behavioral issues, or other pertinent information. (e.g. Diabetes, Asthma, ADD, ADHD, Autism, Dyslexia, Seizure Disorder, Allergies, etc.)
MEDICAL INFORMATION AND MEDICAL RELEASE
Family Doctor / Medico Familiar
REQUIRED
Please fill out this field.
Please enter valid data.
Doctor's phone number/Número de teléfono
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Company
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Policy Number
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Group Number
REQUIRED
Please fill out this field.
Please enter valid data.
Name of Emergency Contact(s)/Nombre del contacto(s) de emergencia
REQUIRED
Please fill out this field.
Please enter valid data.
Phone Number of Emergency Contact(s) (cell, work, home)/Número de teléfono del contacto de emergencia (celular, trabajo, hogar)
REQUIRED
Please fill out this field.
Please enter valid data.
In the event of an emergency where medical treatment is required, I give my permission to the church staff or sponsor to obtain the services of a licensed physician. Please attempt to notify me immediately concerning any such emergency.
I Agree
Please select this field.
RELIGIOUS EDUCATION PARTICIPATION CONSENT FORM
If you would like your child to participate in this event, please select agree to the following statement of consent and release of liability.
As a parent or legal guardian, you remain fully responsible for the actions and conduct of your child.
"I hereby consent to participation by my child(ren), in St Mary's 2022 - 2023 Religious Education Program. I understand this event will take place within the three parish collaborative on the parish grounds of St Charles, Coldwater, Our Lady of Fatima, Union City and/or St Mary's Assumption, Bronson and my child(ren) will be under the supervision of the designated parish employee on the stated dates.
I further consent to the conditions stated above on participation in this event. In consideration of my child(ren) being allowed to participate in this event, I hereby agree on behalf of myself, and my child, to release the Parishes of St. Charles, Coldwater, Our Lady of Fatima, Union City and/or St. Mary's Assumption, Bronson, The Diocese of Kalamazoo and any and all affiliated organizations, their employees, agents, and representatives, including volunteers (collectively “Releasees”), from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. In the event this release on behalf of myself and/or my child(ren) is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releasees from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. This release of indemnification does not apply to the extent of commercial insurance coverage for any claim, but this Release of Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim."
I Agree
Please select this field.
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
PHOTO RELEASE FORM
St Mary's Assumption church Bronson, St Charles, Coldwater, and Our Lady of Fatima, Union City does not publish photos of recognizable persons without consent. If you agree with a recognizable image of your child to publish, please read this consent form, and click your agreement.
I Agree
Please select this field.
Child 3
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Middle Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Gender - Género REQUIRED
REQUIRED
(Select One)
Male
Female
Please fill out this field.
Sacraments already received - Sacramentos que ya recibió el niño(a)
REQUIRED
Baptism
First Confession / Reconciliation
First Holy Communion
Please fill out this field.
Date of Birth - Día de Nacimiento
REQUIRED
Please fill out this field.
Please enter valid data.
Grade for fall 2022 - Grado que cursará este otoño 2022
REQUIRED
(Select One)
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Please fill out this field.
MEDICAL CONDITIONS
List MEDICAL DIAGNOSIS or BEHAVIORAL CONDITIONS and MEDICATIONS TAKEN for any allergies, medical problems, behavioral issues, or other pertinent information. (e.g. Diabetes, Asthma, ADD, ADHD, Autism, Dyslexia, Seizure Disorder, Allergies, etc.)
MEDICAL INFORMATION AND MEDICAL RELEASE
Family Doctor / Medico Familiar
REQUIRED
Please fill out this field.
Please enter valid data.
Doctor's phone number/Número de teléfono
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Company
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Policy Number
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Group Number
REQUIRED
Please fill out this field.
Please enter valid data.
Name of Emergency Contact(s)/Nombre del contacto(s) de emergencia
REQUIRED
Please fill out this field.
Please enter valid data.
Phone Number of Emergency Contact(s) (cell, work, home)/Número de teléfono del contacto de emergencia (celular, trabajo, hogar)
REQUIRED
Please fill out this field.
Please enter valid data.
In the event of an emergency where medical treatment is required, I give my permission to the church staff or sponsor to obtain the services of a licensed physician. Please attempt to notify me immediately concerning any such emergency.
I Agree
Please select this field.
RELIGIOUS EDUCATION PARTICIPATION CONSENT FORM
If you would like your child to participate in this event, please select agree to the following statement of consent and release of liability.
As a parent or legal guardian, you remain fully responsible for the actions and conduct of your child.
"I hereby consent to participation by my child(ren), in St Mary's 2022 - 2023 Religious Education Program. I understand this event will take place within the three parish collaborative on the parish grounds of St Charles, Coldwater, Our Lady of Fatima, Union City and/or St Mary's Assumption, Bronson and my child(ren) will be under the supervision of the designated parish employee on the stated dates.
I further consent to the conditions stated above on participation in this event. In consideration of my child(ren) being allowed to participate in this event, I hereby agree on behalf of myself, and my child, to release the Parishes of St. Charles, Coldwater, Our Lady of Fatima, Union City and/or St. Mary's Assumption, Bronson, The Diocese of Kalamazoo and any and all affiliated organizations, their employees, agents, and representatives, including volunteers (collectively “Releasees”), from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. In the event this release on behalf of myself and/or my child(ren) is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releasees from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. This release of indemnification does not apply to the extent of commercial insurance coverage for any claim, but this Release of Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim."
I Agree
Please select this field.
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
PHOTO RELEASE FORM
St Mary's Assumption church Bronson, St Charles, Coldwater, and Our Lady of Fatima, Union City does not publish photos of recognizable persons without consent. If you agree with a recognizable image of your child to publish, please read this consent form, and click your agreement.
I Agree
Please select this field.
Child 4
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Middle Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Gender - Género REQUIRED
REQUIRED
(Select One)
Male
Female
Please fill out this field.
Sacraments already received - Sacramentos que ya recibió el niño(a)
REQUIRED
Baptism
First Confession / Reconciliation
First Holy Communion
Please fill out this field.
Date of Birth - Día de Nacimiento
REQUIRED
Please fill out this field.
Please enter valid data.
Grade for fall 2022 - Grado que cursará este otoño 2022
REQUIRED
(Select One)
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Please fill out this field.
MEDICAL CONDITIONS
List MEDICAL DIAGNOSIS or BEHAVIORAL CONDITIONS and MEDICATIONS TAKEN for any allergies, medical problems, behavioral issues, or other pertinent information. (e.g. Diabetes, Asthma, ADD, ADHD, Autism, Dyslexia, Seizure Disorder, Allergies, etc.)
MEDICAL INFORMATION AND MEDICAL RELEASE
Family Doctor / Medico Familiar
REQUIRED
Please fill out this field.
Please enter valid data.
Doctor's phone number/Número de teléfono
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Company
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Policy Number
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Group Number
REQUIRED
Please fill out this field.
Please enter valid data.
Name of Emergency Contact(s)/Nombre del contacto(s) de emergencia
REQUIRED
Please fill out this field.
Please enter valid data.
Phone Number of Emergency Contact(s) (cell, work, home)/Número de teléfono del contacto de emergencia (celular, trabajo, hogar)
REQUIRED
Please fill out this field.
Please enter valid data.
In the event of an emergency where medical treatment is required, I give my permission to the church staff or sponsor to obtain the services of a licensed physician. Please attempt to notify me immediately concerning any such emergency.
I Agree
Please select this field.
RELIGIOUS EDUCATION PARTICIPATION CONSENT FORM
If you would like your child to participate in this event, please select agree to the following statement of consent and release of liability.
As a parent or legal guardian, you remain fully responsible for the actions and conduct of your child.
"I hereby consent to participation by my child(ren), in St Mary's 2022 - 2023 Religious Education Program. I understand this event will take place within the three parish collaborative on the parish grounds of St Charles, Coldwater, Our Lady of Fatima, Union City and/or St Mary's Assumption, Bronson and my child(ren) will be under the supervision of the designated parish employee on the stated dates.
I further consent to the conditions stated above on participation in this event. In consideration of my child(ren) being allowed to participate in this event, I hereby agree on behalf of myself, and my child, to release the Parishes of St. Charles, Coldwater, Our Lady of Fatima, Union City and/or St. Mary's Assumption, Bronson, The Diocese of Kalamazoo and any and all affiliated organizations, their employees, agents, and representatives, including volunteers (collectively “Releasees”), from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. In the event this release on behalf of myself and/or my child(ren) is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releasees from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. This release of indemnification does not apply to the extent of commercial insurance coverage for any claim, but this Release of Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim."
I Agree
Please select this field.
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
PHOTO RELEASE FORM
St Mary's Assumption church Bronson, St Charles, Coldwater, and Our Lady of Fatima, Union City does not publish photos of recognizable persons without consent. If you agree with a recognizable image of your child to publish, please read this consent form, and click your agreement.
I Agree
Please select this field.
Child 5
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Middle Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Gender - Género REQUIRED
REQUIRED
(Select One)
Male
Female
Please fill out this field.
Sacraments already received - Sacramentos que ya recibió el niño(a)
REQUIRED
Baptism
First Confession / Reconciliation
First Holy Communion
Please fill out this field.
Date of Birth - Día de Nacimiento
REQUIRED
Please fill out this field.
Please enter valid data.
Grade for fall 2022 - Grado que cursará este otoño 2022
REQUIRED
(Select One)
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Please fill out this field.
MEDICAL CONDITIONS
List MEDICAL DIAGNOSIS or BEHAVIORAL CONDITIONS and MEDICATIONS TAKEN for any allergies, medical problems, behavioral issues, or other pertinent information. (e.g. Diabetes, Asthma, ADD, ADHD, Autism, Dyslexia, Seizure Disorder, Allergies, etc.)
MEDICAL INFORMATION AND MEDICAL RELEASE
Family Doctor / Medico Familiar
REQUIRED
Please fill out this field.
Please enter valid data.
Doctor's phone number/Número de teléfono
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Company
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Policy Number
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Group Number
REQUIRED
Please fill out this field.
Please enter valid data.
Name of Emergency Contact(s)/Nombre del contacto(s) de emergencia
REQUIRED
Please fill out this field.
Please enter valid data.
Phone Number of Emergency Contact(s) (cell, work, home)/Número de teléfono del contacto de emergencia (celular, trabajo, hogar)
REQUIRED
Please fill out this field.
Please enter valid data.
In the event of an emergency where medical treatment is required, I give my permission to the church staff or sponsor to obtain the services of a licensed physician. Please attempt to notify me immediately concerning any such emergency.
I Agree
Please select this field.
RELIGIOUS EDUCATION PARTICIPATION CONSENT FORM
If you would like your child to participate in this event, please select agree to the following statement of consent and release of liability.
As a parent or legal guardian, you remain fully responsible for the actions and conduct of your child.
"I hereby consent to participation by my child(ren), in St Mary's 2022 - 2023 Religious Education Program. I understand this event will take place within the three parish collaborative on the parish grounds of St Charles, Coldwater, Our Lady of Fatima, Union City and/or St Mary's Assumption, Bronson and my child(ren) will be under the supervision of the designated parish employee on the stated dates.
I further consent to the conditions stated above on participation in this event. In consideration of my child(ren) being allowed to participate in this event, I hereby agree on behalf of myself, and my child, to release the Parishes of St. Charles, Coldwater, Our Lady of Fatima, Union City and/or St. Mary's Assumption, Bronson, The Diocese of Kalamazoo and any and all affiliated organizations, their employees, agents, and representatives, including volunteers (collectively “Releasees”), from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. In the event this release on behalf of myself and/or my child(ren) is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releasees from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. This release of indemnification does not apply to the extent of commercial insurance coverage for any claim, but this Release of Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim."
I Agree
Please select this field.
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
PHOTO RELEASE FORM
St Mary's Assumption church Bronson, St Charles, Coldwater, and Our Lady of Fatima, Union City does not publish photos of recognizable persons without consent. If you agree with a recognizable image of your child to publish, please read this consent form, and click your agreement.
I Agree
Please select this field.
Child 6
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Middle Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Gender - Género REQUIRED
REQUIRED
(Select One)
Male
Female
Please fill out this field.
Sacraments already received - Sacramentos que ya recibió el niño(a)
REQUIRED
Baptism
First Confession / Reconciliation
First Holy Communion
Please fill out this field.
Date of Birth - Día de Nacimiento
REQUIRED
Please fill out this field.
Please enter valid data.
Grade for fall 2022 - Grado que cursará este otoño 2022
REQUIRED
(Select One)
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Please fill out this field.
MEDICAL CONDITIONS
List MEDICAL DIAGNOSIS or BEHAVIORAL CONDITIONS and MEDICATIONS TAKEN for any allergies, medical problems, behavioral issues, or other pertinent information. (e.g. Diabetes, Asthma, ADD, ADHD, Autism, Dyslexia, Seizure Disorder, Allergies, etc.)
MEDICAL INFORMATION AND MEDICAL RELEASE
Family Doctor / Medico Familiar
REQUIRED
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Doctor's phone number/Número de teléfono
REQUIRED
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Please enter valid data.
Health Insurance Company
REQUIRED
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Please enter valid data.
Health Insurance Policy Number
REQUIRED
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Health Insurance Group Number
REQUIRED
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Please enter valid data.
Name of Emergency Contact(s)/Nombre del contacto(s) de emergencia
REQUIRED
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Please enter valid data.
Phone Number of Emergency Contact(s) (cell, work, home)/Número de teléfono del contacto de emergencia (celular, trabajo, hogar)
REQUIRED
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Please enter valid data.
In the event of an emergency where medical treatment is required, I give my permission to the church staff or sponsor to obtain the services of a licensed physician. Please attempt to notify me immediately concerning any such emergency.
I Agree
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RELIGIOUS EDUCATION PARTICIPATION CONSENT FORM
If you would like your child to participate in this event, please select agree to the following statement of consent and release of liability.
As a parent or legal guardian, you remain fully responsible for the actions and conduct of your child.
"I hereby consent to participation by my child(ren), in St Mary's 2022 - 2023 Religious Education Program. I understand this event will take place within the three parish collaborative on the parish grounds of St Charles, Coldwater, Our Lady of Fatima, Union City and/or St Mary's Assumption, Bronson and my child(ren) will be under the supervision of the designated parish employee on the stated dates.
I further consent to the conditions stated above on participation in this event. In consideration of my child(ren) being allowed to participate in this event, I hereby agree on behalf of myself, and my child, to release the Parishes of St. Charles, Coldwater, Our Lady of Fatima, Union City and/or St. Mary's Assumption, Bronson, The Diocese of Kalamazoo and any and all affiliated organizations, their employees, agents, and representatives, including volunteers (collectively “Releasees”), from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. In the event this release on behalf of myself and/or my child(ren) is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releasees from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. This release of indemnification does not apply to the extent of commercial insurance coverage for any claim, but this Release of Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim."
I Agree
Please select this field.
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
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Please enter valid data.
PHOTO RELEASE FORM
St Mary's Assumption church Bronson, St Charles, Coldwater, and Our Lady of Fatima, Union City does not publish photos of recognizable persons without consent. If you agree with a recognizable image of your child to publish, please read this consent form, and click your agreement.
I Agree
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Child 7
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
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Please enter valid data.
First Name
REQUIRED
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Middle Name
REQUIRED
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Last Name
REQUIRED
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Please enter valid data.
Gender - Género REQUIRED
REQUIRED
(Select One)
Male
Female
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Sacraments already received - Sacramentos que ya recibió el niño(a)
REQUIRED
Baptism
First Confession / Reconciliation
First Holy Communion
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Date of Birth - Día de Nacimiento
REQUIRED
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Please enter valid data.
Grade for fall 2022 - Grado que cursará este otoño 2022
REQUIRED
(Select One)
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
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MEDICAL CONDITIONS
List MEDICAL DIAGNOSIS or BEHAVIORAL CONDITIONS and MEDICATIONS TAKEN for any allergies, medical problems, behavioral issues, or other pertinent information. (e.g. Diabetes, Asthma, ADD, ADHD, Autism, Dyslexia, Seizure Disorder, Allergies, etc.)
MEDICAL INFORMATION AND MEDICAL RELEASE
Family Doctor / Medico Familiar
REQUIRED
Please fill out this field.
Please enter valid data.
Doctor's phone number/Número de teléfono
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Company
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Policy Number
REQUIRED
Please fill out this field.
Please enter valid data.
Health Insurance Group Number
REQUIRED
Please fill out this field.
Please enter valid data.
Name of Emergency Contact(s)/Nombre del contacto(s) de emergencia
REQUIRED
Please fill out this field.
Please enter valid data.
Phone Number of Emergency Contact(s) (cell, work, home)/Número de teléfono del contacto de emergencia (celular, trabajo, hogar)
REQUIRED
Please fill out this field.
Please enter valid data.
In the event of an emergency where medical treatment is required, I give my permission to the church staff or sponsor to obtain the services of a licensed physician. Please attempt to notify me immediately concerning any such emergency.
I Agree
Please select this field.
RELIGIOUS EDUCATION PARTICIPATION CONSENT FORM
If you would like your child to participate in this event, please select agree to the following statement of consent and release of liability.
As a parent or legal guardian, you remain fully responsible for the actions and conduct of your child.
"I hereby consent to participation by my child(ren), in St Mary's 2022 - 2023 Religious Education Program. I understand this event will take place within the three parish collaborative on the parish grounds of St Charles, Coldwater, Our Lady of Fatima, Union City and/or St Mary's Assumption, Bronson and my child(ren) will be under the supervision of the designated parish employee on the stated dates.
I further consent to the conditions stated above on participation in this event. In consideration of my child(ren) being allowed to participate in this event, I hereby agree on behalf of myself, and my child, to release the Parishes of St. Charles, Coldwater, Our Lady of Fatima, Union City and/or St. Mary's Assumption, Bronson, The Diocese of Kalamazoo and any and all affiliated organizations, their employees, agents, and representatives, including volunteers (collectively “Releasees”), from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. In the event this release on behalf of myself and/or my child(ren) is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releasees from any and all claims, including negligence, which may be asserted by me or my child(ren), or on behalf of my child(ren) arising from or relating to my child(ren)’s participation in the event. This release of indemnification does not apply to the extent of commercial insurance coverage for any claim, but this Release of Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim."
I Agree
Please select this field.
NAME OF PARENT OR LEGAL GUARDIAN GIVING CONSENT - NOMBRE DEL PADRE O TUTOR LEGAL QUE OTORGA EL CONSENTIMIENTO
REQUIRED
Please fill out this field.
Please enter valid data.
PHOTO RELEASE FORM
St Mary's Assumption church Bronson, St Charles, Coldwater, and Our Lady of Fatima, Union City does not publish photos of recognizable persons without consent. If you agree with a recognizable image of your child to publish, please read this consent form, and click your agreement.
I Agree
Please select this field.
Submit
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