ST. MALACHY ROMAN CATHOLIC CHURCH
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St. Malachy's CCD Family/Student Information for 2021-2022 School Year
Please fill in the following information.
Father's Information
Father's Name
*
First
Last
Father's Work Phone
*
Father's Cell Phone
*
Father's Home Phone
*
Father's Email Address
*
Mother's Information
Mother's Name
*
First
Last
Mother's Work Phone
*
Mother's Cell Phone
*
Mother's Home Phone
*
Mother's Email Address
*
Marital Status: Check One.
*
Single
Married
Separated
Divorced
Widowed
Emergency Contact Information (If unable to contact parents)
Emergency Contact Name
*
First
Last
Emergency Cell Phone
*
Emergency Home Phone
*
Emergency Work Phone
*
Relationship
*
Home/Mailing Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mailing Address (If different from home)
*
Line 1
Line 2
City
State
Zip Code
Country
Child's Information - Child 1
*
Indicates required field
Child 1: First Name
*
Child 1: Middle Name
*
Child 1: Last Name
*
Child 1: Birth Date (MM/DD/YYYY)
*
Child 1: Birth Place
*
Child 1: School Grade
*
Child 1: Sacraments (Check if Received)
*
Baptism
Reconciliation
Eucharist
Confirmation
Child 1: Special Needs: (Allergies, Medical Concerns, Etc.)
*
Child's Information - Child 2
Child 2: First Name
*
Child 2: Middle Name
*
Child 2: Last Name
*
Child 2: Birth Date (MM/DD/YYYY)
*
Child 2: Birth Place
*
Child 2: School Grade
*
Child 2: Sacraments (Check if Received)
*
Baptism
Reconciliation
Eucharist
Confirmation
Child 2: Special Needs: (Allergies, Medical Concerns, Etc.)
*
Child's Information - Child 3
Child 3: First Name
*
Child 3: Middle Name
*
Child 3: Last Name
*
Child 3: Birth Date (MM/DD/YYYY)
*
Child 3: Birth Place
*
Child 3: School Grade
*
Child 3: Sacraments (Check if Received)
*
Baptism
Reconciliation
Eucharist
Confirmation
Child 3: Special Needs: (Allergies, Medical Concerns, Etc.)
*
Annual - Online - Youth Authorization 2021-2022 - R22-B
Release of Liability Form
-
Diocese of Fresno (DOF) and all Entities of the
Diocese of Fresno:
Permission for a Minor to Participate in a DOF Online Events and Activities
Parent / Guardian: In order for your child to attend and/or participate in DOF
-
sponsored online events
or activities during this academic year (until we are prepared to offer in
-
person sessions), you must
give your signed permission by completing this
A
NNUAL
form.
NAME OF PARISH OR SCHOOL:
St. Malachy Church
NAME OF GROUP:
CCD
I, the undersigned parent or legal guardian, voluntarily wish to give permission for and request that my
child be allowed to participate in DOF
-
sponsored online events and activities during this academic
year, until in
-person sessions are allowed.
I have informed my child to cooperate and conform with the rules, guidelines, and instructions given by DOF personnel, agents, chaperones, or those persons responsible for DOF online events and activities.
If requested;
I reserve the right to disallow my child to participate in DOF
-
sponsored events by notifying the leader in writing.
I understand that participation in this activity involves their presence online for sessions and activities as outlined by the parish, according to their guidelines.
Please Note: As a extra security precaution
–
the parent or guardian must be nearby or in the same
room as their child while my child is online and participating in the online activity.
** I will need to provide
SEPARATE WRITTEN PERMISSION
to the parish for my child to be online while
NOT in my presence.
I further understand that I may be contacted if my child misbehaves in any way that distracts from the
session and possible be asked that my child be removed from the session.
I will go over the
“
Code of Conduct” for online use, at
the bottom of this page,
with my child and make
sure he/she is aware of the code of conduct and agrees to follow the guidelines on the form.
In exchange for permitting my child to participate in this voluntary online activity, I waive and give up all
claims (and the right to file a lawsuit) which I or my child (and our successors, heirs, and assigns) may
have against DOF. I release and discharge DOF from any and all liability or responsibility for death, illness, personal injury, or property damage arising out of the DOF activity.
This permission, waiver, release, and consent applies to the
DOF
named, including but not limited to the
Diocese of Fresno Education Corporation; the Roman Catholic Bishop of Fresno (a corporate sole); the
Diocese of Fresno; other Fresno Diocesan Parishes and Schools; affiliated organizations and officers; clergy; agents; and employees.
I, the undersigned, have read this release and understand all of its terms. I request that my child be
allowed to participate in DOF
-
sponsored online events and activities. I execute this form voluntarily and
with full knowledge of its significance. I have discussed the above with my child, and my child is aware
of and understands the importance of following all rules set out for these events, or activities. A copy
or digital image of this form shall be as valid as the original authorization and may be given to the adult
leader of the online events.
NAME OF PARTICIPANT
*
DATE (MM/DD/YYYY)
*
NAME OF PARENT / LEGAL GUARDIAN
*
SIGNATURE OF PARENT / LEGAL GUARDIAN
*
Annual - Code Of Conduct For Participants R-24
Diocese of Fresno (DOF) and all Entities of the Diocese of Fresno: Permission for a Minor to
Participate in DOF Online Activities
The following information is to be reviewed with the child, and signed by all:
I agree to politely obey the requests and directions of the adult leaders.
I agree to give my full attention as I participate in the approved activities at all times.
I agree to dress appropriately at all times.
I agree to be on time to activities and remain on the online session until it is dismissed. I will not utilize the
“chat” function unless prompted to do so.
I agree to treat others with respect and will not engage in behavior that reflects poorly on me. I agree not to
participate in hazing, teasing, bullying, or similar activities.
I agree not to misuse the technology needed by posting inappropriate images, visiting other websites during the
session, or distracting my classmates in any way.
I will take responsibility for my actions and understand that my parent/guardian will be contacted if I do not
comply with this Code of Conduct to the satisfaction of the adult leaders.
NAME OF PARTICIPANT
*
DATE OF BIRTH (MM/DD/YYYY)
*
SIGNATUE OF PARTICIPANT
*
NAME OF PARENT / LEGAL GUARDIAN
*
PAGER / CELLULAR TELEPHONE NUMBER
*
DAYTIME TELEPHONE
*
EVENING TELEPHONE
*
EMERGENCY CONTACT (OTHER THAN PARENT / GUARDIAN)
*
RELATIONSHIP
*
EMERGENCY CONTACT DAYTIME TELEPHONE
*
EMERGENCY CONTACT EVENING TELEPHONE
*
OTHER INFORMATION
*
Submit
Annual - Online - Youth Authorization 2021-2022 - R22-B
+
Annual - Code of Conduct for Participants R-24
Release of Liability Form
-
Diocese of Fresno (DOF) and all Entities of the
Diocese of Fresno:
Permission for a Minor to Participate in a DOF Online Events and Activities
Parent / Guardian: In order for your child to attend and/or participate in DOF
-
sponsored online events
or activities during this academic year (until we are prepared to offer in
-
person sessions), you must
give your signed permission by completing this
A
NNUAL
form.
*
Indicates required field
NAME OF PARISH OR SCHOOL
*
NAME OF GROUP
*
I, the undersigned parent or legal guardian, voluntarily wish to give permission for and request that my
child be allowed to participate in DOF
-
sponsored online events and activities during this academic
year, until in
-person sessions are allowed.
I have informed my child to cooperate and conform with the rules, guidelines, and instructions given by DOF personnel, agents, chaperones, or those persons responsible for DOF online events and activities.
If requested;
I reserve the right to disallow my child to participate in DOF
-
sponsored events by notifying the leader in writing.
I understand that participation in this activity involves their presence online for sessions and activities as outlined by the parish, according to their guidelines.
Please Note: As a extra security precaution
–
the parent or guardian must be nearby or in the same
room as their child while my child is online and participating in the online activity.
** I will need to provide
SEPARATE WRITTEN PERMISSION
to the parish for my child to be online while
NOT in my presence.
I further understand that I may be contacted if my child misbehaves in any way that distracts from the
session and possible be asked that my child be removed from the session.
I will go over the
“
Code of Conduct” for online use, at
the bottom of this page,
with my child and make
sure he/she is aware of the code of conduct and agrees to follow the guidelines on the form.
In exchange for permitting my child to participate in this voluntary online activity, I waive and give up all
claims (and the right to file a lawsuit) which I or my child (and our successors, heirs, and assigns) may
have against DOF. I release and discharge DOF from any and all liability or responsibility for death, illness, personal injury, or property damage arising out of the DOF activity.
This permission, waiver, release, and consent applies to the
DOF
named, including but not limited to the
Diocese of Fresno Education Corporation; the Roman Catholic Bishop of Fresno (a corporate sole); the
Diocese of Fresno; other Fresno Diocesan Parishes and Schools; affiliated organizations and officers; clergy; agents; and employees.
I, the undersigned, have read this release and understand all of its terms. I request that my child be
allowed to participate in DOF
-
sponsored online events and activities. I execute this form voluntarily and
with full knowledge of its significance. I have discussed the above with my child, and my child is aware
of and understands the importance of following all rules set out for these events, or activities. A copy
or digital image of this form shall be as valid as the original authorization and may be given to the adult
leader of the online events.
NAME OF PARTICIPANT
*
DATE (MM/DD/YYYY)
*
NAME OF PARENT / LEGAL GUARDIAN
*
SIGNATURE OF PARENT / LEGAL GUARDIAN
*
Annual - Code Of Conduct For Participants R-24
Diocese of Fresno (DOF) and all Entities of the Diocese of Fresno: Permission for a Minor to
Participate in DOF Online Activities
The following information is to be reviewed with the child, and signed by all:
I agree to politely obey the requests and directions of the adult leaders.
I agree to give my full attention as I participate in the approved activities at all times.
I agree to dress appropriately at all times.
I agree to be on time to activities and remain on the online session until it is dismissed. I will not utilize the
“chat” function unless prompted to do so.
I agree to treat others with respect and will not engage in behavior that reflects poorly on me. I agree not to
participate in hazing, teasing, bullying, or similar activities.
I agree not to misuse the technology needed by posting inappropriate images, visiting other websites during the
session, or distracting my classmates in any way.
I will take responsibility for my actions and understand that my parent/guardian will be contacted if I do not
comply with this Code of Conduct to the satisfaction of the adult leaders.
NAME OF PARTICIPANT
*
DATE OF BIRTH (MM/DD/YYYY)
*
SIGNATUE OF PARTICIPANT
*
NAME OF PARENT / LEGAL GUARDIAN
*
DAYTIME TELEPHONE
*
EMERGENCY CONTACT (OTHER THAN PARENT / GUARDIAN)
*
EMERGENCY CONTACT DAYTIME TELEPHONE
*
PAGER / CELLULAR TELEPHONE NUMBER
*
EVENING TELEPHONE
*
RELATIONSHIP
*
EMERGENCY CONTACT EVENING TELEPHONE
*
OTHER INFORMATION
*
Submit
Home
Live Mass
Religious Education
Religious Education Signup Forms
Ministries
Faith Community Nurse Ministry
Liturgical Ministries
Ministries of Community
Ministries of Prayer
Organizations
Catholic Daughters of the Americas
Guadalupe Society
Knights of Columbus
St. Vincent de Paul Society
Sacrament Preparation
Clergy Corner
About Us
Contact Us
Parish Calendar