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Religious Education

- The St. Ludmila Religious Education Program is dedicated to providing the Catholic community of Cedar Rapids with a dynamic learning environment that is rich in faith formation, Catholic doctrine and religious celebration.
- Contact Us
  
  We are proud of our Religious Education families as they live out the Gospel message through “loving God, and loving others." If you have a child who doesn’t attend a Catholic school, there is still time to enroll them in the Religious Education Program.
  
  Monica Rannals Director of Religious Education   319.362.8148 or email: dbq029re@dbqarch.org
  
  Sandy Tanberg RE Administrative Assistant  319.362.8148 or email: dbq029ffsec@dbqarch.org
  
  Summer Office hours: By appointment. To schedule an appointment please email Monica Rannals at dbq029re@dbqarch.org
- St. Ludmila Online Religious Education Form 2020-2021
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Please send your tuition 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.
  
  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 REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Religion Please enter valid data.
  
  Mother's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Maiden Name Please enter valid data.
  
  Marital Status
  
  Street 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.
  
  If parent addresses are different; should communications be sent to both parents/guardians? Yes No
  
  If you answered yes, enter address of parent/guardian not listed above (please include email) Please enter valid data.
  
  If you answered NO, Who should receive information: Mother Father Guardian
  
  Email address where communications are to be sent: This year we will be emailing information/communications to conserve paper. Please enter valid data.
  
  Check here if you wish to receive a paper copy Yes
  
  Home phone Please enter valid data.
  
  Cell Phone Please enter valid data.
  
  Work Phone Please enter valid data.
  
  Name of Emergency Contact and Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Family Doctor Name 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 REQUIRED Please fill out this field. Please enter valid data.
  
  Policy Number REQUIRED Please fill out this field. Please enter valid data.
  
  Children live with: REQUIRED Please fill out this field.
  
  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.
  
  This child will receive Religious Education through which option, "In Class" or Home School"? REQUIRED In Class Home School Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Current Grade (20/21) Please enter valid data.
  
  Name of Public School Attending Please enter valid data.
  
  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 in the 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 REQUIRED Yes NO Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 paragragh above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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. REQUIRED yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 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. REQUIRED Yes No Please fill out this field.
  
  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.
  
  This child will receive Religious Education through which option, "In Class" or Home School"? REQUIRED In Class Home School Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Current Grade (20/21) Please enter valid data.
  
  Name of Public School Attending Please enter valid data.
  
  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 in the 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 REQUIRED Yes NO Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 paragragh above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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. REQUIRED yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 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. REQUIRED Yes No Please fill out this field.
  
  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.
  
  This child will receive Religious Education through which option, "In Class" or Home School"? REQUIRED In Class Home School Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Current Grade (20/21) Please enter valid data.
  
  Name of Public School Attending Please enter valid data.
  
  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 in the 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 REQUIRED Yes NO Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 paragragh above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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. REQUIRED yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 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. REQUIRED Yes No Please fill out this field.
  
  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.
  
  This child will receive Religious Education through which option, "In Class" or Home School"? REQUIRED In Class Home School Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Current Grade (20/21) Please enter valid data.
  
  Name of Public School Attending Please enter valid data.
  
  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 in the 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 REQUIRED Yes NO Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 paragragh above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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. REQUIRED yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 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. REQUIRED Yes No Please fill out this field.
  
  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.
  
  This child will receive Religious Education through which option, "In Class" or Home School"? REQUIRED In Class Home School Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Current Grade (20/21) Please enter valid data.
  
  Name of Public School Attending Please enter valid data.
  
  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 in the 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 REQUIRED Yes NO Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 paragragh above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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. REQUIRED yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 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. REQUIRED Yes No Please fill out this field.
  
  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.
  
  This child will receive Religious Education through which option, "In Class" or Home School"? REQUIRED In Class Home School Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Current Grade (20/21) Please enter valid data.
  
  Name of Public School Attending Please enter valid data.
  
  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 in the 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 REQUIRED Yes NO Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 paragragh above, answer yes or no to question on Asthma prescription. If yes, I agree to writing and presenting a document describing the Asthma condition. REQUIRED Yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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. REQUIRED yes No Please fill out this field.
  
  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 REQUIRED Yes No Please fill out this field.
  
  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 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. REQUIRED Yes No Please fill out this field.
  
  Submit
- Registration
  
  RE Parent Handboo k
  
  RE Home School Registration Form and waiver
  
  RE Home School Policy
  
  RE 2020-2021 Registration Form and Consent & Waiver Form
Be a Blessing
- St. Ludmila Rel. Ed. students are putting together "Blessing Bags" for the homeless. We invite you to also think about doing this and "be a blessing" to someone in need.
  
  Using a gallon size plastic bag fill it with items that would help sustain someone for a day or more. The bag may contain these items: small hand sanitizer or bar soap, toothpaste/toothbrush, small deodorant, shampoo packet, granola bar or crackers, small bottle of water, chapstick, small fruit packet, etc. Dollar stores are great for finding things that could be put into the bag. A gift card would also be appreciated. Make sure you write a prayer of blessings and let the person know you are praying for him/her. Keep this bag in your car and as you see a need, give it to that person. Let us continue to be "blessings to one another."