2025-2026 Online registration

FAMILY 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.

Street Address REQUIRED Please fill out this field. Please enter valid data.

Street Address 2 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.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Parent 2 (First and Last Name) Please enter valid data.

Street Address (if different than Parent 1) Please enter valid data.

Address 2 Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Phone Number (please include area code) Please enter valid data.

Email Please enter an email address.

If parents have different addresses, where should mail be sent to: Parent 1 Parent 2 Both

FAMILY MEDICAL INFORMATION

Emergency Contact (Cannot be a parent listed above) REQUIRED Please fill out this field. Please enter valid data.

Relationship to Student(s) REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact's Phone Number (please include area code) REQUIRED Please fill out this field. Please enter valid data.

Family Doctor or Hospital Name REQUIRED Please fill out this field. Please enter valid data.

Family Doctor or Hospital Phone Number (please include area code) REQUIRED Please fill out this field. Please enter valid data.

Health Plan Carrier REQUIRED Please fill out this field. Please enter valid data.

Health Plan Policy Number REQUIRED Please fill out this field. Please enter valid data.

If your student(s) has any medical information that we should be aware of, please list their name and medical information in the text box below. This could include, but not limited to: allergies, asthma, dietary needs, physical limitations, etc.

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.
Grade Level REQUIRED Please fill out this field.
Gender REQUIRED Please fill out this field.
Date of Birth REQUIRED Please fill out this field. Please enter valid data.
NEW POLICY for 2025-2026: Students with a 504 plan, IEP, etc. will be required to have a parent/grandparent/guardian attend classes with them. Please indicate below.
If this child has asthma, there is an additional form to be completed. Please contact the Pastoral Office.
Please select the program and / or sacrament that you wish to enroll your child in.
Faith Formation Options REQUIRED Wednesday Night (grades K-8) Sacraments only - St Joseph student St. John School of Religion (9-12) Please fill out this field.
Sacraments REQUIRED First Reconciliation / First Eucharist (Grade 2 +) Confirmation (Grade 10 +). Please contact the parish office about the fee. It is paid separately from registration. None Please fill out this field.

CHILD 2

First Name Please enter valid data.

Last Name Please enter valid data.
Grade Level
Gender
Date of Birth Please enter valid data.
NEW POLICY for 2025-2026: Students with a 504 plan, IEP, etc. will be required to have a parent/grandparent/guardian attend classes with them. Please indicate below.
If this child has asthma, there is an additional form to be completed. Please contact the Pastoral Office.
Please select the program and / or sacrament that you wish to enroll your child in.
Faith Formation Options Wednesday Night (grades K-8) Sacraments only - St Joseph student St. John School of Religion (9-12)
Sacraments First Reconciliation / First Eucharist (Grade 2 +) Confirmation (Grade 10 +). Please contact the parish office about the fee. It is paid separately from registration. None

CHILD 3

First Name Please enter valid data.

Last Name Please enter valid data.
Grade Level
Gender
Date of Birth Please enter valid data.
NEW POLICY for 2025-2026: Students with a 504 plan, IEP, etc. will be required to have a parent/grandparent/guardian attend classes with them. Please indicate below.
If this child has asthma, there is an additional form to be completed. Please contact the Pastoral Office.
Please select the program and / or sacrament that you wish to enroll your child in.
Faith Formation Options Wednesday Night (grades K-8) Sacraments only - St Joseph student St. John School of Religion (9-12)
Sacraments First Reconciliation / First Eucharist (Grade 2 +) Confirmation (Grade 10 +). Please contact the parish office about the fee. It is paid separately from registration. None

CHILD 4

First Name Please enter valid data.

Last Name Please enter valid data.
Grade Level
Gender
Date of Birth Please enter valid data.
NEW POLICY for 2025-2026: Students with a 504 plan, IEP, etc. will be required to have a parent/grandparent/guardian attend classes with them. Please indicate below.
If this child has asthma, there is an additional form to be completed. Please contact the Pastoral Office.
Please select the program and / or sacrament that you wish to enroll your child in.
Faith Formation Options Wednesday Night (grades K-8) Sacraments only - St Joseph student St. John School of Religion (9-12)
Sacraments First Reconciliation / First Eucharist (Grade 2 +) Confirmation (Grade 10 +). Please contact the parish office about the fee. It is paid separately from registration. None

CHILD 5

First Name Please enter valid data.

Last Name Please enter valid data.
Grade Level
Gender
Date of Birth Please enter valid data.
NEW POLICY for 2025-2026: Students with a 504 plan, IEP, etc. will be required to have a parent/grandparent/guardian attend classes with them. Please indicate below.
If this child has asthma, there is an additional form to be completed. Please contact the Pastoral Office.
Please select the program and / or sacrament that you wish to enroll your child in.
Faith Formation Options Wednesday Night (grades K-8) Sacraments only - St Joseph student St. John School of Religion (9-12)
Sacraments First Reconciliation / First Eucharist (Grade 2 +) Confirmation (Grade 10 +). Please contact the parish office about the fee. It is paid separately from registration. None

CHILD 6

First Name Please enter valid data.

Last Name Please enter valid data.
Grade Level
Gender
Date of Birth Please enter valid data.
NEW POLICY for 2025-2026: Students with a 504 plan, IEP, etc. will be required to have a parent/grandparent/guardian attend classes with them. Please indicate below.
If this child has asthma, there is an additional form to be completed. Please contact the Pastoral Office.
Please select the program and / or sacrament that you wish to enroll your child in.
Faith Formation Options Wednesday Night (grades K-8) Sacraments only - St Joseph student St. John School of Religion (9-12)
Sacraments First Reconciliation / First Eucharist (Grade 2 +) Confirmation (Grade 10 +). Please contact the parish office about the fee. It is paid separately from registration. None

Archdiocese of Dubuque
2025-2026 Annual Parental/Guardian Consent Form and Liability Waiver
Valid date signed through 8-31-2026

This Consent Form and Liability Waiver is required for and serves both on-site programs and off-site/field trip events/activities for the stated program year. This form needs to be completed annually for each student. To obtain the needed permission, contact, emergency and medical information you are requested to supply the needed information. As the specifics of each off-site/field trip event are known you will be required to complete an Off-site/Field Trip Permission Form outlining the specifics of each activity. Please complete all sections.

CONSENT AND LIABILITY WAIVER

I grant permission for my child(ren) to participate in school/parish events this year that may require transportation to a location away from the school/parish site. The activities will take place under the guidance and direction of school/parish employees and/or volunteers of Good Shepherd Cluster.

As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor(s) (“Participant(s)”). 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 Good Shepherd Cluster and agents, and the Archdiocese of Dubuque, chaperones, 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, its officers, directors and agents, and the Archdiocese of Dubuque, chaperones, 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/school or the Archdiocese of Dubuque.

I agree 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.

I agree REQUIRED Yes No Please fill out this field.

ILLNESS NOTIFICATION

In the event it comes to the attention of the parish/school, its officers, directors and agents, and the Archdiocese of Dubuque, chaperones, or representatives associated with the activity that my child becomes ill with symptoms such as vomiting, sore throat, fever, diarrhea, I want to be notified.

I agree REQUIRED Yes No Please fill out this field.

NON-PRESCRIPTION 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 the on site program.

I agree 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 use in social media or on a parish/cluster website.

I agree REQUIRED Yes No Please fill out this field.

If you answered a question in the above waiver section that does not pertain to all children being registered, please provide additional information below.

Comments:

ELECTRONIC SIGNATURE

Please enter your FIRST NAME and LAST NAME

Please check one of the following:

Yes = I am the parent/guardian of the particant(s) 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" below.

No = I am unwilling to sign form electronically. I understand that I must contact the parish office for a hard copy 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.

I agree REQUIRED Yes No Please fill out this field.

PAYMENT INFORMATION

Faith Formation and Home Preparation (grades K-8) - $75 per student per year
First Reconciliation / First Communion - $55 per student (one time fee)
St. John School of Religion - $125 per student per year
Confirmation - $25 per student (1 time fee)

Wednesday Night Faith Formation (grades K-8)

75.0 – Registration Fee

How many students in Wednesday Program (grades K-8)? Please enter an integer (number).

St John School of Religion

125.0 – Registration Fee

How many students attending St John School of Religion? Please enter an integer (number).

First Reconciliation / First Eucharist (Grade 2 +)

55.0 – Registration fee

How many students receiving their First Reconciliation and First Eucharist? Please enter an integer (number).

Confirmation

25.0 – Registration fee

How many students receiving their Confirmation? Please enter an integer (number).

How do you intend to pay? REQUIRED Pay the full amount due now online Pay in person with cash or check Please contact me to discuss payment installment options Please contact me with financial assistance information or any other questions Please fill out this field.

If you are selecting anything other than "Pay the full amount due now online", please select the "Pay Later" button at the bottom.

2025-2026 Online registration

Good Shepherd Cluster
K-8 Faith Formation, Sacraments & St. John's 9-12

Registration Forms