Family Information

Parishioner Declaration

Ss. Peter and Paul, along with our feeder parishes, is dedicated to promoting Catholic Education to all students. The cost to provide Catholic Education is subsidized for the children of Active Parishioners. An Active Parishioner meets the following requirements:
• Be a registered parishioner at Ss. Peter and Paul, Waterloo, St. Augustine of Canterbury, Hecker, or one of our neighboring parishes.
• Attend Mass regularly (Note – Mass attendance is most commonly recognized through the use of offering envelopes.)
• Make stewardship contributions of time, talent, and treasure. (Stewardship is recognized through your participation and involvement in various parish ministries and parish projects as well as through your use of your parish offering envelopes. We ask that you donate a minimum of $10/week to your parish.)

Parental Permission With Liability Release

The undersigned, being the lawful parent and/or guardian of the above named child(ren) (hereinafter referred to as “Child(ren)”), hereby consents to the participation of said Child(ren) in the Ss. Peter and Paul Parish School of Religion Program (the “Program”) and to said Child(ren) participating in all events relating to the activities through the Program.

The undersigned further authorizes any of the staff, employees, representatives and agents of the Program to provide for, approve and authorize any health care relating to medical emergencies at any hospital, emergency room, doctor’s office or other needed for such health care; review and if necessary disclose the contents of any medical records; execute any consent form required by medical, dental or other health authority incident to the provision of medical, surgical or dental care to said Child(ren). Health care shall include but not be limited to the administration of anesthesia, X-ray examination, performance of operations, diagnostic and other procedures in the stance of a medical emergency wherein the undersigned parent(s) and/or guardian(s) cannot be contacted. The Organizer will first use all reasonable efforts to contact the parent(s) and/or guardian(s) before administering or authorizing any treatments, but in no instance shall have any authority to make determination as to life-sustaining procedures for said Child(ren).

This Consent Form may be revoked at any time by the parent and/or guardian with written notice to the Program and the Organizer.

Caritas Family Solutions Child Protection Video

Caritas Family Solutions will present an age appropriate Child Protection Video to Ss. Peter and Paul PSR students. Students will be grouped by classes for the presentations.

All parishes within the Diocese of Belleville are required to offer this program to their students, however, attendance by the students is optional. It is required that each parent complete the information below for each child that is enrolled in PSR, whether they attend the video presentation or not. If this form is not returned before the presentation is given, your child will not be able to view the video or participate in the discussion afterwards.

Child Release For for Video/Photographs

The undersigned, being the lawful parent and/or guardian of the child named below (hereinafter referred to as “Child”), hereby consents and grants permission to the use of any video, photographs, or any other visual or audio reproductions of my child(ren) without compensation. I understand that these visual or audio productions may be used by the parish or Diocese of Belleville for videos, web pages and/or organization Facebook page, class and school projects, exhibits, promotions or fundraising. Pictures may also be submitted to the local newspapers for publishing. I release the parish and the Diocese of Belleville from any liability connected with the use of any visual or audio formats for the purposes listed above.
This Consent Form will be in effect until revoked by the parent and/or guardian with written notice to the program and the organizer. This consent form can be revoked at any time with written notice to program and the organizer.