RE Registration 24-25

Please be sure to fill out the registration form for all K-10th grade students in entirity and submit your electronic payment at the bottom of the form. Tuition rates are listed below. If you would like a paper copy of the registration form, please contact Cassie Davis, RE Secretary at [email protected].

Registered Members of St. Ludmila Parish? REQUIRED Yes No Please fill out this field.

If not St. Ludmila, What parish do you belong to? Please enter valid data.

Father's Information

First Name Please enter valid data.

Last Name Please enter valid data.

Father's Religion Please enter valid data.

Mother's Information

First Name Please enter valid data.

Last Name Please enter valid data.

Mother's Religion Please enter valid data.

Mother's Maiden Name Please enter valid data.

Marital Status

Primary Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Secondary Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Who should receive information: Mother Father Guardian Other (Please specify)

Email address where communications are to be sent. REQUIRED Please fill out this field. Please enter an email address.

Email address where communications are to be sent. Please enter an email address.

Check here if you wish to receive a paper copy of weekly communications. Yes

If you are interested in becoming a substitute Catechist, please check the box below. Yes

Help support our Religious Education program! Volunteer for one or more opportunities below!

I am interested in serving as a: Catechist Catechist Assistant Substitute Catechist Hall Monitor Children's Liturgy Family Formation Night

-Catechist: Help grow the faith of young people as role models and teachers. Catechists are provided a manual and basic lesson plans for the year to guide your teachings. Catechists must be18 or older. Catechists are needed for Sunday and Wednesday classes.

-Catechist Assistant: Model the faith and work side by side with the Catechist to lead the class in discovering the truth, goodness, and beauty of the Catholic faith. Tasks may include gathering supplies, helping manage classroom expectations, participating in small group discussions, etc. Assistants are needed for Sunday and Wednesday classes.

-Substitute Catechist: Perfect for those that want to help, but cannot commit to a weekly schedule. Materials and lesson plans are provided.

-Hall Monitor: Welcome students as they enter the building, gather attendance, assist with tasks as needed. Hall Monitors are needed for Sunday and Wednesday classes.

-Children's Liturgy: Lead children in their own Liturgy of the Word one Sunday a month. This individual will walk chilren from the worship space to the classroom after the opening prayer and return to the worship space after the homily. Materials for that specific Mass will be provided.

-Family Formation Night: Assist the CRE with planning, preparing, serving, and/or clean up of the meal provided. Assist with the programming and activities for the evening. Family Formation Night takes place three times a year.

TUITION RATES 2024-2025

Homeschool Rates:

In-Person Rates:

* CONFIRMATION FEE: $155.00

Mother/Adult Phone Please enter valid data.

Father/Adult Phone Please enter valid data.

Other Phone Please enter valid data.

Name of Emergency Contact and Phone Please enter valid data.

Family Doctor Name Please enter valid data.

Family Doctor Phone Number Please enter valid data.

Family Health Plan Carrier Please enter valid data.

Policy Number Please enter valid data.

Children live with:

If you selected "Other" for who the children live with, please explain Please enter valid data.

Please list all persons living in your home: Please enter valid data.

How many children will be registering? REQUIRED Please fill out this field.
Child 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.
- Method of Religious Education REQUIRED In Class Home School Confirmation (In-Person Only) Please fill out this field.
- *Please note: If you have children in both the Religious Education and Home School Program, the In-Person Religious Education Fee will apply.
- If you choose In-Person classes, what day/time will your child(ren) attend? REQUIRED Sunday 9:10-10:20 AM Wednesday 5:45-7:00PM Confirmation (Class dates TBD) Please fill out this field.
- **Disclaimer: The class day/time selected will be locked in for the entirety of the school year. Students will not be allowed to make up day/nights with the other class times due to limited space for class sizes.
- If you choose Homeschooling, which method is best for your families learning? Printed Materials for Pick-Up (3x/year) Digital copies provided to the email below
- Gender
- Date of Birth Please enter a date.
- Upcoming Grade (2024-2025) REQUIRED Please fill out this field. Please enter valid data.
- Name of Public School Attending Please enter valid data.
- Student Email (Grades 6-10): Please enter valid data.
- Student Phone Number (Grades 6-10): Please enter valid data.
- *Student contact information requested for Grades 6-10^th and will be not be shared with anyone other than the Confirmation Coordinator and Youth Minister for event and special reminder purposes.
- My child has received the following Sacraments REQUIRED Baptism Reconciliation First Communion Please fill out this field.
- Please select all that apply to this child: Chronic illnesses or physical limiatations Any type of learning difficulty Does this child attend special education classes or utilize a 504 or IEP Plan in their public school?
- If you selected any option from the above list, please provide any information that we may need and how we can help. Please enter valid data.
- -Parent/Guardian Consent Form and Liability Waiver Required Permissions-
- CONSENT AND LIABILITY WAIVER
  
  This Consent and Liability waiver is required for and serves both on-site programs and off-site/field trip events/activities for the stated program year. I grant permission for my child to participate in parish/cluster events this year that may require transportation to a location away from the parish/cluster site. The activities will take place under the guidance and direction of parish/cluster employees and/or volunteers. As a 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 parish/cluster and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster, its officers, directors and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster or the Archdiocese of Dubuque.
- I have read the above paragraph and grant my permission, answer yes or no Yes NO
- EMERGENCY MEDICAL TREATMENT PERMISSION
  
  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. 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 contact the emergency contacts/locations as listed in this online registration process.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ILLNESS NOTIFICATION
  
  In the event it comes to the attention of the parish/cluster, its officers, directors and agents and the Archdiocese of Dubuque, chaperons, or representatives associated with any off-site activity or while at parish/cluster that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I wish to be notified.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- 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 a parish/cluster program/activity.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ALLERGY INFORMATION
  
  Does this child have allergic reactions? (medications, foods, plants, insects etc.) If yes, please provide a list of known allergies, reactions, and directives.
- Answer Yes or No to the allergy paragraph above, if Yes, I will agree to supply a list of allergies, reactions and directives Yes No
- ASTHMA INFORMATION
  
  Does this child utilize asthma or airway constriction prescription medication? If yes, please provide the parish/cluster with written information on the child’s asthma condition.
- I have read the above Asthma paragraph above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. Yes No
- PRESCRIBED DIET INFORMATION
  
  Does this child have a medically prescribed diet? If yes, please provide the parish/cluster with additional written information on the diet.
- Answer Yes or No to the above Prescribed Diet question. If yes, I agree to writing and presenting a document that describes the Prescribed Diet Yes No
- LIMITATIONS INFORMATION
  
  Does this child have any physical limitations that require accommodations by the parish/cluster? If yes, please provide the parish/cluster with additional written information on the limitations.
- Answer Yes or No to the Limitations question above, If Yes, I agree to writing and presenting a document that describes any limitations. yes No
- OTHER MEDICAL INFORMATION
  
  Does this child have any other medical conditions about which the parish/cluster should be aware? If yes, please provide the parish/cluster with additional written information on the medical conditions.
- Answer Yes or No to the above question on Medical Conditions. If yes, I agree to writing and presenting a document that describes any medical conditions Yes No
- MEDIA RELEASE AND AUTHORIZATION
  
  I understand that by responding “Yes” I hereby grant authority to my child’s parish/cluster for the use of any videos, photos, or similar items to used in social media or on a parish/cluster web page.
- Please answer Yes or No to the above Media Release Question Yes No
- I agree to all terms, guidelines and policies in the St. Ludmila Religious Education Parent Handbook including all requirements regarding the attendance policy, disciplinary action, tuition requirements, and health safety plan. REQUIRED Yes No Please fill out this field.
- Electronic Signature -
  Please enter your First and Last Name: two fill-in boxes (First and Last Name)
  “Please check one of the following:”
  Yes = “I am the parent or guardian of the participant named above and have the legal authority to execute the above permission(s). I consent to signing this document electronically as demonstrated by typing my name and checking “Yes” here.”
  No = “I am unwilling to sign this form electronically. I understand that I must contact the parish office for a hardcopy of the liability waiver before my child can participate in the program.”
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Answer Yes or No to the Electronic Signature question as described in the above paragraph. Yes No
- **Please select the correlated payment amount with checkbox(s) below for the method of Religious Education and associated children to attend. Only type an amount in "Other" field for specified circumstances that have been discussed with Cassie Davis at [email protected].
  
  Other methods of payment (check, cash, etc)
  Please send your tuition check payment to:
  St. Ludmila Parish
  2107 J Street SW, Cedar Rapids, Iowa 52404
  
  Please include the names of children who will be taking classes on the memo line of the check.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Method of Religious Education REQUIRED In Class Home School Confirmation (In-Person Only) Please fill out this field.
- *Please note: If you have children in both the Religious Education and Home School Program, the In-Person Religious Education Fee will apply.
- If you choose In-Person classes, what day/time will your child(ren) attend? REQUIRED Sunday 9:10-10:20 AM Wednesday 5:45-7:00PM Confirmation (Class dates TBD) Please fill out this field.
- **Disclaimer: The class day/time selected will be locked in for the entirety of the school year. Students will not be allowed to make up day/nights with the other class times due to limited space for class sizes.
- If you choose Homeschooling, which method is best for your families learning? Printed Materials for Pick-Up (3x/year) Digital copies provided to the email below
- Gender
- Date of Birth Please enter a date.
- Upcoming Grade (2024-2025) REQUIRED Please fill out this field. Please enter valid data.
- Name of Public School Attending Please enter valid data.
- Student Email (Grades 6-10): Please enter valid data.
- Student Phone Number (Grades 6-10): Please enter valid data.
- *Student contact information requested for Grades 6-10^th and will be not be shared with anyone other than the Confirmation Coordinator and Youth Minister for event and special reminder purposes.
- My child has received the following Sacraments REQUIRED Baptism Reconciliation First Communion Please fill out this field.
- Please select all that apply to this child: Chronic illnesses or physical limiatations Any type of learning difficulty Does this child attend special education classes or utilize a 504 or IEP Plan in their public school?
- If you selected any option from the above list, please provide any information that we may need and how we can help. Please enter valid data.
- -Parent/Guardian Consent Form and Liability Waiver Required Permissions-
- CONSENT AND LIABILITY WAIVER
  
  This Consent and Liability waiver is required for and serves both on-site programs and off-site/field trip events/activities for the stated program year. I grant permission for my child to participate in parish/cluster events this year that may require transportation to a location away from the parish/cluster site. The activities will take place under the guidance and direction of parish/cluster employees and/or volunteers. As a 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 parish/cluster and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster, its officers, directors and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster or the Archdiocese of Dubuque.
- I have read the above paragraph and grant my permission, answer yes or no Yes NO
- EMERGENCY MEDICAL TREATMENT PERMISSION
  
  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. 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 contact the emergency contacts/locations as listed in this online registration process.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ILLNESS NOTIFICATION
  
  In the event it comes to the attention of the parish/cluster, its officers, directors and agents and the Archdiocese of Dubuque, chaperons, or representatives associated with any off-site activity or while at parish/cluster that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I wish to be notified.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- 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 a parish/cluster program/activity.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ALLERGY INFORMATION
  
  Does this child have allergic reactions? (medications, foods, plants, insects etc.) If yes, please provide a list of known allergies, reactions, and directives.
- Answer Yes or No to the allergy paragraph above, if Yes, I will agree to supply a list of allergies, reactions and directives Yes No
- ASTHMA INFORMATION
  
  Does this child utilize asthma or airway constriction prescription medication? If yes, please provide the parish/cluster with written information on the child’s asthma condition.
- I have read the above Asthma paragraph above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. Yes No
- PRESCRIBED DIET INFORMATION
  
  Does this child have a medically prescribed diet? If yes, please provide the parish/cluster with additional written information on the diet.
- Answer Yes or No to the above Prescribed Diet question. If yes, I agree to writing and presenting a document that describes the Prescribed Diet Yes No
- LIMITATIONS INFORMATION
  
  Does this child have any physical limitations that require accommodations by the parish/cluster? If yes, please provide the parish/cluster with additional written information on the limitations.
- Answer Yes or No to the Limitations question above, If Yes, I agree to writing and presenting a document that describes any limitations. yes No
- OTHER MEDICAL INFORMATION
  
  Does this child have any other medical conditions about which the parish/cluster should be aware? If yes, please provide the parish/cluster with additional written information on the medical conditions.
- Answer Yes or No to the above question on Medical Conditions. If yes, I agree to writing and presenting a document that describes any medical conditions Yes No
- MEDIA RELEASE AND AUTHORIZATION
  
  I understand that by responding “Yes” I hereby grant authority to my child’s parish/cluster for the use of any videos, photos, or similar items to used in social media or on a parish/cluster web page.
- Please answer Yes or No to the above Media Release Question Yes No
- I agree to all terms, guidelines and policies in the St. Ludmila Religious Education Parent Handbook including all requirements regarding the attendance policy, disciplinary action, tuition requirements, and health safety plan. REQUIRED Yes No Please fill out this field.
- Electronic Signature -
  Please enter your First and Last Name: two fill-in boxes (First and Last Name)
  “Please check one of the following:”
  Yes = “I am the parent or guardian of the participant named above and have the legal authority to execute the above permission(s). I consent to signing this document electronically as demonstrated by typing my name and checking “Yes” here.”
  No = “I am unwilling to sign this form electronically. I understand that I must contact the parish office for a hardcopy of the liability waiver before my child can participate in the program.”
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- TUITION RATES 2023-2024
  
  Homeschool Rates:
  
  In-Person Rates:
  
  * CONFIRMATION FEE: $155.00
- Answer Yes or No to the Electronic Signature question as described in the above paragraph. Yes No
- **Please select the correlated payment amount with checkbox(s) below for the method of Religious Education and associated children to attend. Only type an amount in "Other" field for specified circumstances that have been discussed with Cassie Davis at [email protected].
  
  Other methods of payment (check, cash, etc)
  Please send your tuition check payment to:
  St. Ludmila Parish
  2107 J Street SW, Cedar Rapids, Iowa 52404
  
  Please include the names of children who will be taking classes on the memo line of the check.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Method of Religious Education REQUIRED In Class Home School Confirmation (In-Person Only) Please fill out this field.
- *Please note: If you have children in both the Religious Education and Home School Program, the In-Person Religious Education Fee will apply.
- If you choose In-Person classes, what day/time will your child(ren) attend? REQUIRED Sunday 9:10-10:20 AM Wednesday 5:45-7:00PM Confirmation (Class dates TBD) Please fill out this field.
- **Disclaimer: The class day/time selected will be locked in for the entirety of the school year. Students will not be allowed to make up day/nights with the other class times due to limited space for class sizes.
- If you choose Homeschooling, which method is best for your families learning? Printed Materials for Pick-Up (3x/year) Digital copies provided to the email below
- Gender
- Date of Birth Please enter a date.
- Upcoming Grade (2024-2025) REQUIRED Please fill out this field. Please enter valid data.
- Name of Public School Attending Please enter valid data.
- Student Email (Grades 6-10): Please enter valid data.
- Student Phone Number (Grades 6-10): Please enter valid data.
- *Student contact information requested for Grades 6-10^th and will be not be shared with anyone other than the Confirmation Coordinator and Youth Minister for event and special reminder purposes.
- My child has received the following Sacraments REQUIRED Baptism Reconciliation First Communion Please fill out this field.
- Please select all that apply to this child: Chronic illnesses or physical limiatations Any type of learning difficulty Does this child attend special education classes or utilize a 504 or IEP Plan in their public school?
- If you selected any option from the above list, please provide any information that we may need and how we can help. Please enter valid data.
- -Parent/Guardian Consent Form and Liability Waiver Required Permissions-
- CONSENT AND LIABILITY WAIVER
  
  This Consent and Liability waiver is required for and serves both on-site programs and off-site/field trip events/activities for the stated program year. I grant permission for my child to participate in parish/cluster events this year that may require transportation to a location away from the parish/cluster site. The activities will take place under the guidance and direction of parish/cluster employees and/or volunteers. As a 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 parish/cluster and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster, its officers, directors and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster or the Archdiocese of Dubuque.
- I have read the above paragraph and grant my permission, answer yes or no Yes NO
- EMERGENCY MEDICAL TREATMENT PERMISSION
  
  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. 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 contact the emergency contacts/locations as listed in this online registration process.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ILLNESS NOTIFICATION
  
  In the event it comes to the attention of the parish/cluster, its officers, directors and agents and the Archdiocese of Dubuque, chaperons, or representatives associated with any off-site activity or while at parish/cluster that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I wish to be notified.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- 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 a parish/cluster program/activity.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ALLERGY INFORMATION
  
  Does this child have allergic reactions? (medications, foods, plants, insects etc.) If yes, please provide a list of known allergies, reactions, and directives.
- Answer Yes or No to the allergy paragraph above, if Yes, I will agree to supply a list of allergies, reactions and directives Yes No
- ASTHMA INFORMATION
  
  Does this child utilize asthma or airway constriction prescription medication? If yes, please provide the parish/cluster with written information on the child’s asthma condition.
- I have read the above Asthma paragraph above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. Yes No
- PRESCRIBED DIET INFORMATION
  
  Does this child have a medically prescribed diet? If yes, please provide the parish/cluster with additional written information on the diet.
- Answer Yes or No to the above Prescribed Diet question. If yes, I agree to writing and presenting a document that describes the Prescribed Diet Yes No
- LIMITATIONS INFORMATION
  
  Does this child have any physical limitations that require accommodations by the parish/cluster? If yes, please provide the parish/cluster with additional written information on the limitations.
- Answer Yes or No to the Limitations question above, If Yes, I agree to writing and presenting a document that describes any limitations. yes No
- OTHER MEDICAL INFORMATION
  
  Does this child have any other medical conditions about which the parish/cluster should be aware? If yes, please provide the parish/cluster with additional written information on the medical conditions.
- Answer Yes or No to the above question on Medical Conditions. If yes, I agree to writing and presenting a document that describes any medical conditions Yes No
- MEDIA RELEASE AND AUTHORIZATION
  
  I understand that by responding “Yes” I hereby grant authority to my child’s parish/cluster for the use of any videos, photos, or similar items to used in social media or on a parish/cluster web page.
- Please answer Yes or No to the above Media Release Question Yes No
- I agree to all terms, guidelines and policies in the St. Ludmila Religious Education Parent Handbook including all requirements regarding the attendance policy, disciplinary action, tuition requirements, and health safety plan. REQUIRED Yes No Please fill out this field.
- Electronic Signature -
  Please enter your First and Last Name: two fill-in boxes (First and Last Name)
  “Please check one of the following:”
  Yes = “I am the parent or guardian of the participant named above and have the legal authority to execute the above permission(s). I consent to signing this document electronically as demonstrated by typing my name and checking “Yes” here.”
  No = “I am unwilling to sign this form electronically. I understand that I must contact the parish office for a hardcopy of the liability waiver before my child can participate in the program.”
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Answer Yes or No to the Electronic Signature question as described in the above paragraph. Yes No
- TUITION RATES 2023-2024
  
  Homeschool Rates:
  
  In-Person Rates:
  
  * CONFIRMATION FEE: $155.00
- **Please select the correlated payment amount with checkbox(s) below for the method of Religious Education and associated children to attend. Only type an amount in "Other" field for specified circumstances that have been discussed with Cassie Davis at [email protected].
  
  Other methods of payment (check, cash, etc)
  Please send your tuition check payment to:
  St. Ludmila Parish
  2107 J Street SW, Cedar Rapids, Iowa 52404
  
  Please include the names of children who will be taking classes on the memo line of the check.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Method of Religious Education REQUIRED In Class Home School Confirmation (In-Person Only) Please fill out this field.
- *Please note: If you have children in both the Religious Education and Home School Program, the In-Person Religious Education Fee will apply.
- If you choose In-Person classes, what day/time will your child(ren) attend? REQUIRED Sunday 9:10-10:20 AM Wednesday 5:45-7:00PM Confirmation (Class dates TBD) Please fill out this field.
- **Disclaimer: The class day/time selected will be locked in for the entirety of the school year. Students will not be allowed to make up day/nights with the other class times due to limited space for class sizes.
- If you choose Homeschooling, which method is best for your families learning? Printed Materials for Pick-Up (3x/year) Digital copies provided to the email below
- Gender
- Date of Birth Please enter a date.
- Upcoming Grade (2024-2025) REQUIRED Please fill out this field. Please enter valid data.
- Name of Public School Attending Please enter valid data.
- Student Email (Grades 6-10): Please enter valid data.
- Student Phone Number (Grades 6-10): Please enter valid data.
- *Student contact information requested for Grades 6-10^th and will be not be shared with anyone other than the Confirmation Coordinator and Youth Minister for event and special reminder purposes.
- My child has received the following Sacraments REQUIRED Baptism Reconciliation First Communion Please fill out this field.
- Please select all that apply to this child: Chronic illnesses or physical limiatations Any type of learning difficulty Does this child attend special education classes or utilize a 504 or IEP Plan in their public school?
- If you selected any option from the above list, please provide any information that we may need and how we can help. Please enter valid data.
- -Parent/Guardian Consent Form and Liability Waiver Required Permissions-
- CONSENT AND LIABILITY WAIVER
  
  This Consent and Liability waiver is required for and serves both on-site programs and off-site/field trip events/activities for the stated program year. I grant permission for my child to participate in parish/cluster events this year that may require transportation to a location away from the parish/cluster site. The activities will take place under the guidance and direction of parish/cluster employees and/or volunteers. As a 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 parish/cluster and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster, its officers, directors and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster or the Archdiocese of Dubuque.
- I have read the above paragraph and grant my permission, answer yes or no Yes NO
- EMERGENCY MEDICAL TREATMENT PERMISSION
  
  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. 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 contact the emergency contacts/locations as listed in this online registration process.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ILLNESS NOTIFICATION
  
  In the event it comes to the attention of the parish/cluster, its officers, directors and agents and the Archdiocese of Dubuque, chaperons, or representatives associated with any off-site activity or while at parish/cluster that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I wish to be notified.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- 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 a parish/cluster program/activity.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ALLERGY INFORMATION
  
  Does this child have allergic reactions? (medications, foods, plants, insects etc.) If yes, please provide a list of known allergies, reactions, and directives.
- Answer Yes or No to the allergy paragraph above, if Yes, I will agree to supply a list of allergies, reactions and directives Yes No
- ASTHMA INFORMATION
  
  Does this child utilize asthma or airway constriction prescription medication? If yes, please provide the parish/cluster with written information on the child’s asthma condition.
- I have read the above Asthma paragraph above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. Yes No
- PRESCRIBED DIET INFORMATION
  
  Does this child have a medically prescribed diet? If yes, please provide the parish/cluster with additional written information on the diet.
- Answer Yes or No to the above Prescribed Diet question. If yes, I agree to writing and presenting a document that describes the Prescribed Diet Yes No
- LIMITATIONS INFORMATION
  
  Does this child have any physical limitations that require accommodations by the parish/cluster? If yes, please provide the parish/cluster with additional written information on the limitations.
- Answer Yes or No to the Limitations question above, If Yes, I agree to writing and presenting a document that describes any limitations. yes No
- OTHER MEDICAL INFORMATION
  
  Does this child have any other medical conditions about which the parish/cluster should be aware? If yes, please provide the parish/cluster with additional written information on the medical conditions.
- Answer Yes or No to the above question on Medical Conditions. If yes, I agree to writing and presenting a document that describes any medical conditions Yes No
- MEDIA RELEASE AND AUTHORIZATION
  
  I understand that by responding “Yes” I hereby grant authority to my child’s parish/cluster for the use of any videos, photos, or similar items to used in social media or on a parish/cluster web page.
- Please answer Yes or No to the above Media Release Question Yes No
- I agree to all terms, guidelines and policies in the St. Ludmila Religious Education Parent Handbook including all requirements regarding the attendance policy, disciplinary action, tuition requirements, and health safety plan. REQUIRED Yes No Please fill out this field.
- Electronic Signature -
  Please enter your First and Last Name: two fill-in boxes (First and Last Name)
  “Please check one of the following:”
  Yes = “I am the parent or guardian of the participant named above and have the legal authority to execute the above permission(s). I consent to signing this document electronically as demonstrated by typing my name and checking “Yes” here.”
  No = “I am unwilling to sign this form electronically. I understand that I must contact the parish office for a hardcopy of the liability waiver before my child can participate in the program.”
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Answer Yes or No to the Electronic Signature question as described in the above paragraph. Yes No
- TUITION RATES 2023-2024
  
  Homeschool Rates:
  
  In-Person Rates:
  
  * CONFIRMATION FEE: $155.00
- **Please select the correlated payment amount with checkbox(s) below for the method of Religious Education and associated children to attend. Only type an amount in "Other" field for specified circumstances that have been discussed with Cassie Davis at [email protected].
  
  Other methods of payment (check, cash, etc)
  Please send your tuition check payment to:
  St. Ludmila Parish
  2107 J Street SW, Cedar Rapids, Iowa 52404
  
  Please include the names of children who will be taking classes on the memo line of the check.
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Method of Religious Education REQUIRED In Class Home School Confirmation (In-Person Only) Please fill out this field.
- *Please note: If you have children in both the Religious Education and Home School Program, the In-Person Religious Education Fee will apply.
- If you choose In-Person classes, what day/time will your child(ren) attend? REQUIRED Sunday 9:10-10:20 AM Wednesday 5:45-7:00PM Confirmation (Class dates TBD) Please fill out this field.
- **Disclaimer: The class day/time selected will be locked in for the entirety of the school year. Students will not be allowed to make up day/nights with the other class times due to limited space for class sizes.
- If you choose Homeschooling, which method is best for your families learning? Printed Materials for Pick-Up (3x/year) Digital copies provided to the email below
- Gender
- Date of Birth Please enter a date.
- Upcoming Grade (2024-2025) REQUIRED Please fill out this field. Please enter valid data.
- Name of Public School Attending Please enter valid data.
- Student Email (Grades 6-10): Please enter valid data.
- Student Phone Number (Grades 6-10): Please enter valid data.
- *Student contact information requested for Grades 6-10^th and will be not be shared with anyone other than the Confirmation Coordinator and Youth Minister for event and special reminder purposes.
- My child has received the following Sacraments REQUIRED Baptism Reconciliation First Communion Please fill out this field.
- Please select all that apply to this child: Chronic illnesses or physical limiatations Any type of learning difficulty Does this child attend special education classes or utilize a 504 or IEP Plan in their public school?
- If you selected any option from the above list, please provide any information that we may need and how we can help. Please enter valid data.
- -Parent/Guardian Consent Form and Liability Waiver Required Permissions-
- CONSENT AND LIABILITY WAIVER
  
  This Consent and Liability waiver is required for and serves both on-site programs and off-site/field trip events/activities for the stated program year. I grant permission for my child to participate in parish/cluster events this year that may require transportation to a location away from the parish/cluster site. The activities will take place under the guidance and direction of parish/cluster employees and/or volunteers. As a 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 parish/cluster and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster, its officers, directors and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster or the Archdiocese of Dubuque.
- I have read the above paragraph and grant my permission, answer yes or no Yes NO
- EMERGENCY MEDICAL TREATMENT PERMISSION
  
  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. 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 contact the emergency contacts/locations as listed in this online registration process.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ILLNESS NOTIFICATION
  
  In the event it comes to the attention of the parish/cluster, its officers, directors and agents and the Archdiocese of Dubuque, chaperons, or representatives associated with any off-site activity or while at parish/cluster that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I wish to be notified.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- 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 a parish/cluster program/activity.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ALLERGY INFORMATION
  
  Does this child have allergic reactions? (medications, foods, plants, insects etc.) If yes, please provide a list of known allergies, reactions, and directives.
- Answer Yes or No to the allergy paragraph above, if Yes, I will agree to supply a list of allergies, reactions and directives Yes No
- ASTHMA INFORMATION
  
  Does this child utilize asthma or airway constriction prescription medication? If yes, please provide the parish/cluster with written information on the child’s asthma condition.
- I have read the above Asthma paragraph above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. Yes No
- PRESCRIBED DIET INFORMATION
  
  Does this child have a medically prescribed diet? If yes, please provide the parish/cluster with additional written information on the diet.
- Answer Yes or No to the above Prescribed Diet question. If yes, I agree to writing and presenting a document that describes the Prescribed Diet Yes No
- LIMITATIONS INFORMATION
  
  Does this child have any physical limitations that require accommodations by the parish/cluster? If yes, please provide the parish/cluster with additional written information on the limitations.
- Answer Yes or No to the Limitations question above, If Yes, I agree to writing and presenting a document that describes any limitations. yes No
- OTHER MEDICAL INFORMATION
  
  Does this child have any other medical conditions about which the parish/cluster should be aware? If yes, please provide the parish/cluster with additional written information on the medical conditions.
- Answer Yes or No to the above question on Medical Conditions. If yes, I agree to writing and presenting a document that describes any medical conditions Yes No
- MEDIA RELEASE AND AUTHORIZATION
  
  I understand that by responding “Yes” I hereby grant authority to my child’s parish/cluster for the use of any videos, photos, or similar items to used in social media or on a parish/cluster web page.
- Please answer Yes or No to the above Media Release Question Yes No
- I agree to all terms, guidelines and policies in the St. Ludmila Religious Education Parent Handbook including all requirements regarding the attendance policy, disciplinary action, tuition requirements, and health safety plan. REQUIRED Yes No Please fill out this field.
- Electronic Signature -
  Please enter your First and Last Name: two fill-in boxes (First and Last Name)
  “Please check one of the following:”
  Yes = “I am the parent or guardian of the participant named above and have the legal authority to execute the above permission(s). I consent to signing this document electronically as demonstrated by typing my name and checking “Yes” here.”
  No = “I am unwilling to sign this form electronically. I understand that I must contact the parish office for a hardcopy of the liability waiver before my child can participate in the program.”
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Answer Yes or No to the Electronic Signature question as described in the above paragraph. Yes No
- **Please select the correlated payment amount with checkbox(s) below for the method of Religious Education and associated children to attend. Only type an amount in "Other" field for specified circumstances that have been discussed with Cassie Davis at [email protected].
  
  Other methods of payment (check, cash, etc)
  Please send your tuition check payment to:
  St. Ludmila Parish
  2107 J Street SW, Cedar Rapids, Iowa 52404
  
  Please include the names of children who will be taking classes on the memo line of the check.
- TUITION RATES 2023-2024
  
  Homeschool Rates:
  
  In-Person Rates:
  
  * CONFIRMATION FEE: $155.00
Child 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Method of Religious Education REQUIRED In Class Home School Confirmation (In-Person Only) Please fill out this field.
- *Please note: If you have children in both the Religious Education and Home School Program, the In-Person Religious Education Fee will apply.
- If you choose In-Person classes, what day/time will your child(ren) attend? REQUIRED Sunday 9:10-10:20 AM Wednesday 5:45-7:00PM Confirmation (Class dates TBD) Please fill out this field.
- **Disclaimer: The class day/time selected will be locked in for the entirety of the school year. Students will not be allowed to make up day/nights with the other class times due to limited space for class sizes.
- If you choose Homeschooling, which method is best for your families learning? Printed Materials for Pick-Up (3x/year) Digital copies provided to the email below
- Gender
- Date of Birth Please enter a date.
- Upcoming Grade (2024-2025) REQUIRED Please fill out this field. Please enter valid data.
- Name of Public School Attending Please enter valid data.
- Student Email (Grades 6-10): Please enter valid data.
- Student Phone Number (Grades 6-10): Please enter valid data.
- *Student contact information requested for Grades 6-10^th and will be not be shared with anyone other than the Confirmation Coordinator and Youth Minister for event and special reminder purposes.
- My child has received the following Sacraments REQUIRED Baptism Reconciliation First Communion Please fill out this field.
- Please select all that apply to this child: Chronic illnesses or physical limiatations Any type of learning difficulty Does this child attend special education classes or utilize a 504 or IEP Plan in their public school?
- If you selected any option from the above list, please provide any information that we may need and how we can help. Please enter valid data.
- -Parent/Guardian Consent Form and Liability Waiver Required Permissions-
- CONSENT AND LIABILITY WAIVER
  
  This Consent and Liability waiver is required for and serves both on-site programs and off-site/field trip events/activities for the stated program year. I grant permission for my child to participate in parish/cluster events this year that may require transportation to a location away from the parish/cluster site. The activities will take place under the guidance and direction of parish/cluster employees and/or volunteers. As a 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 parish/cluster and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster, its officers, directors and agents, and the Archdiocese of Dubuque, chaperons, 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/cluster or the Archdiocese of Dubuque.
- I have read the above paragraph and grant my permission, answer yes or no Yes NO
- EMERGENCY MEDICAL TREATMENT PERMISSION
  
  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. 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 contact the emergency contacts/locations as listed in this online registration process.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ILLNESS NOTIFICATION
  
  In the event it comes to the attention of the parish/cluster, its officers, directors and agents and the Archdiocese of Dubuque, chaperons, or representatives associated with any off-site activity or while at parish/cluster that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I wish to be notified.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- 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 a parish/cluster program/activity.
- I have read the above paragraph and grant my permission, answer yes or no Yes No
- ALLERGY INFORMATION
  
  Does this child have allergic reactions? (medications, foods, plants, insects etc.) If yes, please provide a list of known allergies, reactions, and directives.
- Answer Yes or No to the allergy paragraph above, if Yes, I will agree to supply a list of allergies, reactions and directives Yes No
- ASTHMA INFORMATION
  
  Does this child utilize asthma or airway constriction prescription medication? If yes, please provide the parish/cluster with written information on the child’s asthma condition.
- I have read the above Asthma paragraph above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. Yes No
- PRESCRIBED DIET INFORMATION
  
  Does this child have a medically prescribed diet? If yes, please provide the parish/cluster with additional written information on the diet.
- Answer Yes or No to the above Prescribed Diet question. If yes, I agree to writing and presenting a document that describes the Prescribed Diet Yes No
- LIMITATIONS INFORMATION
  
  Does this child have any physical limitations that require accommodations by the parish/cluster? If yes, please provide the parish/cluster with additional written information on the limitations.
- Answer Yes or No to the Limitations question above, If Yes, I agree to writing and presenting a document that describes any limitations. yes No
- OTHER MEDICAL INFORMATION
  
  Does this child have any other medical conditions about which the parish/cluster should be aware? If yes, please provide the parish/cluster with additional written information on the medical conditions.
- Answer Yes or No to the above question on Medical Conditions. If yes, I agree to writing and presenting a document that describes any medical conditions Yes No
- MEDIA RELEASE AND AUTHORIZATION
  
  I understand that by responding “Yes” I hereby grant authority to my child’s parish/cluster for the use of any videos, photos, or similar items to used in social media or on a parish/cluster web page.
- Please answer Yes or No to the above Media Release Question Yes No
- I agree to all terms, guidelines and policies in the St. Ludmila Religious Education Parent Handbook including all requirements regarding the attendance policy, disciplinary action, tuition requirements, and health safety plan. REQUIRED Yes No Please fill out this field.
- Electronic Signature -
  Please enter your First and Last Name: two fill-in boxes (First and Last Name)
  “Please check one of the following:”
  Yes = “I am the parent or guardian of the participant named above and have the legal authority to execute the above permission(s). I consent to signing this document electronically as demonstrated by typing my name and checking “Yes” here.”
  No = “I am unwilling to sign this form electronically. I understand that I must contact the parish office for a hardcopy of the liability waiver before my child can participate in the program.”
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Answer Yes or No to the Electronic Signature question as described in the above paragraph. Yes No
- **Please select the correlated payment amount with checkbox(s) below for the method of Religious Education and associated children to attend. Only type an amount in "Other" field for specified circumstances that have been discussed with Cassie Davis at [email protected].
  
  Other methods of payment (check, cash, etc)
  Please send your tuition check payment to:
  St. Ludmila Parish
  2107 J Street SW, Cedar Rapids, Iowa 52404
  
  Please include the names of children who will be taking classes on the memo line of the check.
- TUITION RATES 2023-2024
  
  Homeschool Rates:
  
  In-Person Rates:
  
  * CONFIRMATION FEE: $155.00

K-9th Homeschool Payment

Select the payment(s) amount which represents which program(s) your child(ren) will be in this 2021-2022 year. Then press "Pay Now" to prompt the payment information system.

83.0 – 1 child

95.0 – 2 Children

103.0 – 3 or More

K-9th In-Person Class Payment

165.0 – 1 Child

190.0 – 2 Children

215.0 – 3 or More

Confirmation Payment

155.0 – 10th Grade Student

Sacraments (First Reconciliation/Eucharist)

30.0 – One time Sacrament Fee

Out of Parish Tuition Fee

35.0 – Out of Parish Tuition Fee

Other Amount

Please contact the RE Office if you have a credit to be applied to this school years tuition!

$ Please enter a positive decimal.

St. Ludmila
Catholic Parish

Cedar Rapids, IA

RE Registration 24-25

St. Ludmila Religious Education Form & Payment Portal 2024-2025

-Parent/Guardian Consent Form and Liability Waiver Required Permissions-

-Parent/Guardian Consent Form and Liability Waiver Required Permissions-

-Parent/Guardian Consent Form and Liability Waiver Required Permissions-

-Parent/Guardian Consent Form and Liability Waiver Required Permissions-

-Parent/Guardian Consent Form and Liability Waiver Required Permissions-

-Parent/Guardian Consent Form and Liability Waiver Required Permissions-