Special Needs Registration — Our Lady of Good Counsel Parish

Special Needs Registration Form: 2024 - 2025 Year

Student's Full Name

Date of Birth

School Attending

Medical and Learning Concerns

Therapist / Aides other than parent attending with student

Please list name, role, email address of any adult who attends sessions as support for student

Recommendations / Accommodations for use by catechists

Primary Adult Contact - Name / Relationship to Student

Mailing Address

Primary Email

Primary Phone

Emergency Contact (Name / Phone / Relationship)

Sacraments preparing for this year

Baptism

Eucharist

Confirmation

New students: Welcome! Note sacraments received. Copies of certificates are to be scanned and emailed to the RE Office.

Promotion Release: I consent to the use of any video and or photographs in which the student may appear by the Diocese of Trenton and / or OLGC Parish. I understand that these materials are being used for promotion of the parish Religious Education Programs.

Policies: By registering in the Religious Education Program you are agreeing to abide by the parish and diocesan policies.

Safe Environment: Parent or authorized adult must attend with the enrolled student. Only one student is permitted in the designed restroom at a time. Parent / authorized adult must accompany student.

Person completing form