Registration for Wednesday RE (Religious Education)

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

Parish you are registered at REQUIRED Please fill out this field. Please enter valid data.

Family's Address (where info about the program will be mailed to) REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

What primary language do you speak at home? REQUIRED Please fill out this field.

Adult information

Adult #1

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Are you interested in any of the following? Formal initiation into the Catholic Church Adult Confirmation Adult small faith sharing groups Marriage preparation in the Catholic faith

Adult #2

First Name Please enter valid data.

Last Name Please enter valid data.
Email Please enter an email address.
Cell Phone
This number will be used for automated text message/email system to notify you regarding last minute changes in schedule, reminders, upcoming events, and cancellations.
Please enter valid data.
Are you interested in any of the following? Formal initiation into the Catholic Church Adult Confirmation Adult small faith sharing groups Marriage preparation in the Catholic faith

Child registration information

Parental Consent & Releases

Media Consent & Release

I understand that, unless I indicate otherwise, I give permission of the Catholic Parishes of Waterloo the use of any video, photographs, or similar items in which my child/children might appear, or statements made by them, on display on the parish website, parish bulletin, or parish social media. Note: no children’s names will be published without specific prior consent.

Media Consent REQUIRED Yes No Please fill out this field.

Off-site/Field Trip Consent Form and Liability Waiver

I grant permission for my child(ren) to participate in school/parish events this year that may require transportation to a location away from the school/parish site. The activities will take place under the guidance and direction of school/parish employees and/or volunteers of the Catholic Parishes of Waterloo.

As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“ Participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend, its officers, directors of the Catholic Parishes of Waterloo, and agents, and the Archdiocese of Dubuque, chaperones, or representatives associated with the events, arising from or in connection with my child attending the events or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Archdiocese of Dubuque, chaperones, or representatives associated with the events for reasonable attorney’s fees and expenses which they may incur in any action I/we may bring against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school or the Archdiocese of Dubuque.

Sepcific Medical Matters

I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.

Emergency Medical Treatment

Item A - Emergency Medical Treatment:

In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers, contact:
Name, Relationship & Phone: REQUIRED Please fill out this field. Please enter valid data.
Family Doctor & Phone Number REQUIRED Please fill out this field. Please enter valid data.
Family Health Plan Carrier & Policy # Please enter valid data.
Item B- Other Medical Treatment
In the event it comes to the attention of the parish/school, its officers, directors and agents, and the Archdiocese of Dubuque, chaperones, or representatives associated with the activity that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I want to be notified.
I wish to be informed if my child(ren) becomes ill (sore throat, vomiting, fever, diarrhea, etc). REQUIRED Yes No Please fill out this field.
On-site Nonprescription Medication Permission

I hereby grant permission for nonprescription medication (such as ibuprofen, Tylenol, throat lozenges, etc.) to be given to my child in the event a condition arises after my child is already in attendance at the on site program.
I give permission to allow my child(ren) to have nonprescription medication if needed. REQUIRED Yes No Please fill out this field.

Fees for the Wednesday, Virtual & Summer RE programs-

1 child- $95.00
2 children- $165.00
3 or more children- $215.00

You must pay something today in order to finish the online registration form. If you can not pay anything today, please call Becky with questions 319-233-0498

Amount based on the number of children: REQUIRED Please fill out this field.

We/I understand that we/I am the key to faith development for our/my children. We/I will provide a supportive and nurturing family life which allows our/my children to experience the beliefs, values and traditions of our Catholic faith. As a family, we will participate fully in the spiritual and sacramental life of the Church by attending mass regularly. We/I will assist our/my child in preparation and celebration of the sacraments and will be actively involved in the faith formation of our/my children.

I Agree Please select this field.

Waterloo Catholics

Registration for Wednesday RE (Religious Education)

2023-2024 Wednesday R.E. Registration

Wednesday RE 2023-2024 Schedule