Candidate Information

First name

Last name

Phone

Email

Gender

Male

Female

Date of Birth

Baptism Information

Has the candidate been baptized Catholic?

Yes

No

First Communion Information

Has the candidate celebrated the sacrament of First Communion?

Yes

No

Emergency Information

In case of emergency, please call:

Name

Relationship

Phone

Medical Release & General Consent

So that we can best serve you, please list any known conditions that we should be made aware of. (i.e. learning disabilities, allergies, medications taken (if needed during class), medical, physical, emotional, behavioral, etc.)

PHOTO OPT OUT

The program often takes photos in class or at special events sponsored by the parish. The photos may be uploaded and

posted to the parish website at times or printed in the parish Sunday bulletin. If you do not want photos of yourself

posted on the website or printed in the Sunday bulletin, please note below

Single choice

I CONSENT to having my photo posted on the website, social media, or printed in the Sunday bulletin.

I DO NOT CONSENT to having my photo posted on the website, social media, or printed in the Sunday bulletin.

I do hereby give permission to be treated for a medical emergency while participating in the RCIA program. In case of accident, I do not hold the Archdiocese of Chicago, the parish (Our Lady of the Holy Family Parish), its staff, or any catechists/chaperones responsible for accident or injury. I understand that all costs incurred will be my responsibility.

Check here to agree to the above

Printed Name

Signature

Are you a Parishioner of Our Lady of the Holy Family Parish?

Yes

No

RCIA Registration

Candidate Information

Baptism Information

First Communion Information

Emergency Information

Medical Release & General Consent