Religious Education Registration 2022-23 April 1, 2021 News Online Registration for Religious Education Step 1 of 6 16% Parent or Guardian Last Name* Mother's First Name Father's First Name Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone/Mom Cell/Dad Cell/Work Number*Emergency Contact Name and Phone Number and Relationship* Student #1 Full Name (First, Middle and Last)* Student <1> Sex* Male Female Student <1> First Choice Class Option*Sunday 5:00 – 6:30 pm (Grades 1-12)Monday 4:45 – 6:15 pm (Grades K-8)RCICHome School/ Catholic SchoolClass options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12), Monday 4:45 – 6:15 PM (Grades K – 8) or Rite of Christian Initiation for Children (RCIC)Student <1> Second Choice Class OptionSunday 5:00 – 6:30 pm (Grades 1-12)Monday 4:45 – 6:15 pm (Grades K-8)Class options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12) or Monday 4:45 – 6:15 PM (Grades K – 8)Student <1> Academic Grade in 2024-25* Check the box if Student <1> has special needs Check the box if Student has special needs If Student <1> requires special needs please provide as much information as possible.Student <1> Birth Year Student <1 > Birth Day of Month*Student <1> Birth Month*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberStudent <1> Sacraments Already Received Baptism First Penance First Holy Communion Confirmation Student <1> Lives With Whom If Student <1> does not live with parents, please list with whom they live and what their relationship to them is. Where did Student <1> receive their Religious Education last year? (Name and location of Parish)* Student <2>Full Name (First, Middle and Last) Student <2> Sex Male Female Student <2> First Choice Class OptionSunday 5:00 – 6:30 pm (Grades 1-12)Monday 4:45 – 6:15 pm (Grades K-8)RCICHome School/ Catholic SchoolClass options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12), Monday 4:45 – 6:15 PM (Grades K – 8) or Rite of Christian Initiation for Children (RCIC)Student <2> Second Choice Class OptionSunday 5:00 – 6:30 pm (Grades 1-12)Monday 4:45 – 6:15 pm (Grades K-8)Class options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12) or Monday 4:45 – 6:15 PM (Grades K – 8)Student <2> Academic Grade in 2024-25 Check the box if Student <2> has special needs Check the box if Student has special needs If Student <2> requires special needs please provide as much information as possible.Student <2> Birth YearStudent <2 > Birth Day of MonthStudent <2> Birth MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberStudent <2> Sacraments Already Received Baptism First Penance First Holy Communion Confirmation Student <2> Lives With Whom If Student <2> does not live with parents, please list with whom they live and what their relationship to them is. Where did Student <2> receive their Religious Education last year? (Name and location of Parish) Student <3 > Full Name (First, Middle and Last) Student <3> Sex Male Female Student <3> First Choice Class OptionSunday 5:00 – 6:30 pm (Grades 1-12)Monday 4:45 – 6:15 pm (Grades K-8)RCICHome School/ Catholic SchoolClass options include: Schedule Sunday 5:00 – 6:30 PM (Grades 1 – 12), Monday 4:45 – 6:15 PM (Grades K – 8) or Rite of Christian Initiation for Children (RCIC)Student <3> Second Choice Class OptionSunday 5:00 – 6:30 pm (Grades 1-12)Monday 4:45 – 6:15 pm (Grades K-8)Class options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12) or Monday 4:45 – 6:15 PM (Grades K – 8)Student <3> Academic Grade in 2024-25 Check the box if Student <3> has special needs Check the box if Student has special needs If Student <3> requires special needs please provide as much information as possible.Student <3> Birth YearStudent <3> Birth Day of MonthStudent <3> Birth MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberStudent <3> Sacraments Already Received Baptism First Penance First Holy Communion Confirmation Where did Student <3> receive their Religious Education last year? (Name and location of Parish) Student <4> Full Name (First, Middle and Last) Student <4> Sex Male Female Student <4> First Choice Class OptionSunday 5:00 – 6:30 pm (Grades 1-12)Monday 4:45 – 6:15 pm (Grades K-8)RCICHome School/ Catholic SchoolClass options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12), Monday 4:45 – 6:15 PM (Grades K – 8) or Rite of Christian Initiation for Children (RCIC)Student <4> Second Choice Class OptionSunday 5:00 – 6:30 pm (Grades 1-12)Monday 4:45 – 6:15 pm (Grades K-8)Class options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12) or Monday 4:45 – 6:15 PM (Grades K – 8)Student <4> Academic Grade in 2024-25 Student <4> Birth YearStudent <4> Birth Day of MonthStudent <4> Birth MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberCheck the box if Student <4> has special needs Check the box if Student has special needs If Student <4> requires special needs please provide as much information as possibleWhere did Student <4> receive their Religious Education last year? (Name and location of Parish) Special Student Accommodations (this information will be kept confidential): Please note any allergies or other pertinent information, including special educational accommodations (IEP, 504, etc.), which will help us to provide a positive learning environment for your child. By leaving this blank, you are stating that your child has no need for special accommodations.I hereby authorize the Diocese of Arlington and St. Raymond of Penafort Catholic Church to use my child’s picture or video for educational and/or marketing purposes. Yes No I acknowledge that I am aware of my role and responsibility of primary catechist of my children. I agree to comply with the policies and requirements of the St. Raymond Religious Education program. Please sign below by typing your full name. Include your relationship to the student(s) and date. SAFE ENVIRONMENT LESSONS The Office of Child Protection and Safety for the Diocese of Arlington provides programs to ensure a safe environment for children within the community of the Church. The Diocese of Arlington requires a training program designed for youth to permit them to be a last line of defense and to ensure every child has the tools necessary to combat abuse. For children in grades 1-12 Religious Education, St. Raymond Catholic Church uses the Circle of Grace program. Contact the RE office for more information. INFORMATION ON THIS PROGRAM IS AVAILABLE ON THE DIOCESAN WEBSITE: http://www.arlingtondiocese.org/Child-Protection/Youth-Training-Programs/ Yes. my child(ren) may participate No, my child(ren) will not participate Carpool Authorization- Name and Phone Number I am able to teach or assist for this school year. Yes Not at this time Interested, but unsure at this time If you are able to teach this year, what grade are you interested in? K 1 2 3 4 5 6 7 8 9 10 11 12 The FCPS Family Life Education Program (FLE) contains elements which compromise Church teachings. Have you opted your child(ren) out of this program? Yes No Untitled