Faith Formation Registration 2022-2023

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Family Information

Parish *

St. Rose of Lima, Topsfield

St. Agnes, Middleton

My family is not registered at a parish. We would like to register at St. Rose.

My family is not registered at a parish. We would like to register at St. Agnes.

My family is registered at another parish and we do not plan to change parishes. (Please list your parish.)

Parish My family is registered at another parish and we do not plan to change parishes. (Please list your parish.)

Primary Address *

Address 1

Address 2

City

State

ZIP code

Home Phone

Please list any family circumstances that you would like us to be aware of and sensitive to (e.g., children in foster care, children living with grandparents, parents separated, parent deceased, one parent not Catholic, etc.)

Parent/Guardian 1

First Name *

Last Name *

Maiden Name (if parent 1 is mother)

Cell Phone *

Email *

Check here if this parent would like more information about volunteering. (If you are registering after September 11 and would like to help out this year, please contact Amy Kostak directly at [email protected])

Please considering sharing your time and talent!

Parent/Guardian 2

First Name

Last Name

Maiden Name (if parent 2 is mother)

Cell Phone

Please considering sharing your time and talent!

Emergency Contact - NOT a parent (to call if neither parent can be reached)

Full Name *

Relation to Child(ren) *

Emergency Contact Phone *

Children

Child 1

First Name *

Middle Name

Last Name *

Sex *

Male

Female

Date of Birth *

Month

Day

Year

Grade (2022-2023) *

Class Time *

Has child been baptized?

Yes

If your child has not been baptized and they are 7 years old or older, they will need to enter RCIC (The Rite of Christian Initiation for Children). This means they will enter a class with other children preparing to receive Baptism, First Communion, and Confirmation; and they will receive all three sacraments at the Easter Vigil. Be sure to select RCIC as your child's class time above. For more information, please call the parish office at 978-774-1958.

Baptismal Information

My child was baptized at St. Rose of Lima Church in Topsfield

My child was baptized at St. Agnes Church in Middleton

I have previously provided my child's Baptismal Certificate from another church.

I have NOT previously provided my child's Baptismal Certificate from another church - please upload a copy below or call the baptismal church to have a copy mailed to us

My child has not been baptized.

If this child was baptized somewhere other than St. Rose or St. Agnes, please upload a copy or clear picture of their Baptismal Certificate. If you have previously provided us with a baptismal certificate, you do not need to provide it now.

If you are not able to find your child's Baptismal Certificate now, please send a copy to the parish office as soon as possible.
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

Please list any health concerns, allergies, special needs, learning disabilities, etc. that we should be aware of.

If you are interested in an adaptive class for your child with special needs, please call Amy Kostak at 978-774-1958.

Child 2

First Name

Middle Name

Last Name

Sex

Male

Female

Date of Birth

Month

Day

Year

Grade (2022-2023)

Class Time

Has child been baptized?

Yes

Baptismal Information

My child was baptized at St. Rose of Lima Church in Topsfield

My child was baptized at St. Agnes Church in Middleton

I have previously provided my child's Baptismal Certificate from another church.

I have NOT previously provided my child's Baptismal Certificate from another church - please upload a copy below or call the baptismal church to have a copy mailed to us.

My child has not been baptized.

Please list any health concerns, allergies, special needs, learning disabilities, etc. that we should be aware of.

If you are interested in an adaptive class for your child with special needs, please call Amy Kostak at 978-774-1958.

Child 3

First Name

Middle Name

Last Name

Sex

Male

Female

Date of Birth

Month

Day

Year

Grade (2022-2023)

Class Time

Has child been baptized?

Yes

Baptismal Information

My child was baptized at St. Rose of Lima Church in Topsfield

My child was baptized at St. Agnes Church in Middleton

I have previously provided my child's Baptismal Certificate from another church.

I have NOT previously provided my child's Baptismal Certificate from another church - please upload a copy below or call the baptismal church to have a copy mailed to us.

My child has not been baptized.

Please list any health concerns, allergies, special needs, learning disabilities, etc. that we should be aware of.

If you are interested in an adaptive class for your child with special needs, please call Amy Kostak at 978-774-1958.

Child 4

First Name

Middle Name

Last Name

Sex

Male

Female

Date of Birth

Month

Day

Year

Grade (2022-2023)

Class Time

Has child been baptized?

Yes

Baptismal Information

My child was baptized at St. Rose of Lima Church in Topsfield

My child was baptized at St. Agnes Church in Middleton

I have previously provided my child's Baptismal Certificate from another church.

I have NOT previously provided my child's Baptismal Certificate from another church - please upload a copy below or call the baptismal church to have a copy mailed to us.

My child has not been baptized.

Please list any health concerns, allergies, special needs, learning disabilities, etc. that we should be aware of.

If you are interested in an adaptive class for your child with special needs, please call Amy Kostak at 978-774-1958.

Child 5

First Name

Middle Name

Last Name

Sex

Male

Female

Date of Birth

Month

Day

Year

Grade (2022-2023)

Class Time

Has child been baptized?

Yes

Baptismal Information

My child was baptized at St. Rose of Lima Church in Topsfield

My child was baptized at St. Agnes Church in Middleton

I have previously provided my child's Baptismal Certificate from another church.

I have NOT previously provided my child's Baptismal Certificate from another church - please upload a copy below or call the baptismal church to have a copy mailed to us.

My child has not been baptized.

Please list any health concerns, allergies, special needs, learning disabilities, etc. that we should be aware of.

If you are interested in an adaptive class for your child with special needs, please call Amy Kostak at 978-774-1958.

Liability Waiver

Liability Waiver *

I irrevocably release from all liability, and hereby agree to indemnify and hold harmless the Roman Catholic Archbishop of Boston, both individually and in his capacity as trustee for the benefit of the Roman Catholic Archdiocese of Boston and all parishes within the Archdiocese, including but not limited to St. Agnes and St. Rose of Lima Parishes, and the officers, agents, representatives, volunteers, chaperones, clergy, religious and employees of either the Archdiocese of Boston or any parish or youth ministry thereof from any and all liability, actions, causes of action, claims, judgments, cost or expenses, including but not limited to attorneys' fees, known or unknown at this time, arising out of or in any way related to any injury or illness or other damages to person or property incurred by my child while participating in or traveling to or from Vacation Bible School.

Photo Release

Photo Release *

We use various digital mediums to provide outreach to our community, to share information regarding upcoming events and current ministries, and to spread God’s word. During religious education events, we would like to take and share photos of the children with parents and with the rest of the parish. Please let us know if you are comfortable with us sharing pictures of your child(ren).

I give permission to St. Agnes and St. Rose of Lima Parishes, to use my child(ren)’s portrait, photograph or video for promotional purposes related to the advancement and development of the ministry of the Roman Catholic Church and the Archdiocese of Boston, and hereby release RCAB and Its Agents from any liability resulting from such use.

I do NOT give my permission for pictures of my child(ren) to be used for promotional purposes.

Comments

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