CLC Registration Form

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED

Enter today's date

Please fill out this field. Please enter a date.

Email REQUIRED

This is used for communication for events and activities, as well as submission and payment confirmation.

Please fill out this field. Please enter an email address.

Parent Information

Father's Name Please enter valid data.
Father's Phone # Maximum 20 characters Please enter a phone number.
Mother's Name Please enter valid data.
Mother's Phone # Maximum 20 characters Please enter a phone number.
Teachers & Aides
Please check any where you are able to assist
Teach Aide Other (indicate below)
Other assistance (please specify)
If you are able to assist in some other way, please share.
Please enter valid data.

Student Information

Number of Children REQUIRED Please fill out this field.
Child 1
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade
- Sacrements Received
  Please check all that apply
  Baptism 1st Comm. Penance Confirmation
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or health care facility for immediate treatment and/or consultation, if deemed necessary. I understand that my emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences which may result from any personal actions (ie. damage to property or other participants/staff) taken by me, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me. I also grant permission to the Church of the Resurrection to use my photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.
Child 2
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade
- Sacrements Received
  Please check all that apply
  Baptism 1st Comm. Penance Confirmation
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or health care facility for immediate treatment and/or consultation, if deemed necessary. I understand that my emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences which may result from any personal actions (ie. damage to property or other participants/staff) taken by me, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me. I also grant permission to the Church of the Resurrection to use my photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.
Child 3
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade
- Sacrements Received
  Please check all that apply
  Baptism 1st Comm. Penance Confirmation
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or health care facility for immediate treatment and/or consultation, if deemed necessary. I understand that my emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences which may result from any personal actions (ie. damage to property or other participants/staff) taken by me, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me. I also grant permission to the Church of the Resurrection to use my photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.
Child 4
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade
- Sacrements Received
  Please check all that apply
  Baptism 1st Comm. Penance Confirmation
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or health care facility for immediate treatment and/or consultation, if deemed necessary. I understand that my emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences which may result from any personal actions (ie. damage to property or other participants/staff) taken by me, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me. I also grant permission to the Church of the Resurrection to use my photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.
Child 5
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade
- Sacrements Received
  Please check all that apply
  Baptism 1st Comm. Penance Confirmation
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or health care facility for immediate treatment and/or consultation, if deemed necessary. I understand that my emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences which may result from any personal actions (ie. damage to property or other participants/staff) taken by me, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me. I also grant permission to the Church of the Resurrection to use my photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.
Child 6
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade
- Sacrements Received
  Please check all that apply
  Baptism 1st Comm. Penance Confirmation
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or health care facility for immediate treatment and/or consultation, if deemed necessary. I understand that my emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences which may result from any personal actions (ie. damage to property or other participants/staff) taken by me, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me. I also grant permission to the Church of the Resurrection to use my photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.

Tuition Cost REQUIRED

Please select the appropriate option for tuition

40.0 – One Child 80.0 – Two Children 90.0 – Family Rate Please fill out this field.

Resurrection Catholic Church

Grand Island, NE

CLC Registration Form