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Whoever eats my flesh and drinks my blood remains in me and I in him.

-John 6:56


Registration Form

St. Dominic Parish School of Religion 

Registration Form 2016-2017

Parents


















Child 1







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Baptismal Certificate

If the child is new to the Program AND was not Baptized at St. Dominic Parish, please upload a copy of their Baptismal Certificate.



If you cannot upload it to us, please bring or send a copy to the Parish Office, Attention: Theresa Eagan.


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 (Usually 2nd grade)



 (Prep begins in 7th grade, Confirmation takes place in 8th grade)




Child 2







RadDatePicker
Open the calendar popup.

Baptismal Certificate

If the child is new to the Program AND was not Baptized at St. Dominic Parish, please upload a copy of their Baptismal Certificate.



If you cannot upload it to us, please bring or send a copy to the Parish Office, Attention: Theresa Eagan.


RadDatePicker
Open the calendar popup.



 (Usually 2nd grade)



 (Prep begins in 7th grade, Confirmation takes place in 8th grade)



Release and Medical POA

Permission-Medical Power of Attorney Agreement


Archdiocese of Cincinnati Release and Indemnification and Medical Power of Attorney Agreement - 

1. I, the lawful parent or guardian of (the"child"), give permission for my child to participate in St. Dominic’s Parish School of Religion (PSR) program and indemnify the Archbishop of Cincinnati (the "Archbishop"), both individually and as trustee for the Archdiocese of Cincinnati and all parishes within the Archdiocese, and their officers, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost of expenses, including attorneys' fees, arising out of any injury or illness incurred by my child while participating in or traveling to or from the activity. 

2. I agree to instruct my child to cooperate with the Archbishop or his agents in charge of the activity. 

3a. I appoint the Archbishop or his agents who are acting as leaders of the activity as my attorney in fact to act for me in my name and my behalf, in any way that I would act if I were personally present, with respect to the following matters if any injury, illness or medical emergency occurs during the activity or related travel: 

(i) To give any and all consents and authorizations to any physicians, dentist, hospital or other person or institutions pertaining to any emergency medications, medical or dental treatments, diagnostic or surgical procedures or any other emergency actions as our attorney shall deem necessary or appropriate for the best interest of the child. 

(ii) I understand that the agents of the Archbishop will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my child. 

3b. This power of attorney shall lapse automatically upon completion of the activity and related travel. 

4. I agree that the Archbishop or his agents may use my child's portrait or photograph for promotional purposes, website and office functions. I have carefully read this statement, and acknowledge that I fully understand the content and meaning.

 













Payment


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