Confirmation Registration Form 2023-24

Confirmation at St. Gabriel takes place for students in the 9th grade.
Our program begins in September and meets on Sunday evenings throughout the year. Confirmation date to be determined. This registration is for students that will be in the 9th grade for the 2023/24 school year. Please be sure to provide a VALID EMAIL ADDRESS THAT YOU CHECK FREQUENTLY as our communication is done through email. A parent meeting will be held in September. Please watch your email for our calendar which will be finalized in May. Fee for the Confirmation program is $60

1Registration Information > 2Payment Information > 3Payment
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A copy of the Baptismal certificate must be provided unless Baptism or First Eucharist were received at St. Gabriel Parish. It can be scanned and emailed to kjubeck@st-gabriel.org or faxed to 440-354-7558, or you can drop it off at the parish office
Student Name Student Name First Last
Birth Date Birth Date / MM / DD YYYY
City, State of Birth
Church of Baptism
Baptism Date
Church of Baptism Address (if other than St. Gabriel) Church of Baptism Address (if other than St. Gabriel)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Father's Name Father's Name First Last
Mother's First and Maiden Name Mother's First and Maiden Name First Last
Email for Parents
Parent Phone Number Parent Phone Number - ### - ### ####
Your Address Your Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
High School in the fall of 2023:
Grade in fall of 2032
Home Parish
Church of First Eucharist
Emergency Medical Authorization Form
To enable parents/guardians to authorize the provision of emergency treatment for children who become ill or injured under school authority, when parents/guardians cannot be reached. Please complete the information below.
Physician's Name Physician's Name First Last
Physician's Phone Physician's Phone - ### - ### ####
Dentist's Name Dentist's Name First Last
Dentist's Phone Dentist's Phone - ### - ### ####
Local Hospital to Transport Student
Facts concerning student's medical history, including allergies, food allergies, medication taken, and any physical impairments of which a physician should be aware. If there are none, please type n/a in the box.
2023-24 School Year
In the event reasonable attempts to contact me have been unsuccessful, I, the legal parent/guardian of student hereby authorize any of the staff, employees, volunteers, agents and/or representatives of st. Gabriel Parish (each as "Authorized party") to provide for, seek, and authorize medical treatment for him/her in the case of illness or accident from the closest and most appropriate licensed medical practitioner or hospital available. This authorization does not cover major surgery unless medical options of two licensed physicians/dentists concurring in the necessity for such surgery are obtained for the performance of such surgery. Any and all information concerning student's history, including allergies, medications and physical impairments, has been reported in these registration forms. In the event of an emergency, I authorize any Authorized party to share the completed registration information packet with persons related to the treatment of my minor child.
Please check one

Please check one Yes, I grant consent No, I do not grant consent. Complete following box
2023-24 School Year
If you refuse to grant consent, please answer the following. In the event of illness or injury requiring medical treatment, I wish the school authorities to take the following action:
Responsibility to Carry Appropriate Medical Insurance
I understand that it is my responsibility to carry appropriate medical insurance for my child and that such is not the responsibility of any other person or party, including, without limitation, St. Gabriel Parish or the Diocese of Cleveland. To the fullest extend allowed by law, I, on behalf of myself, my spouse, my minor child, as well as our respective heirs and assigns, executors, all other legal representatives and any others claiming through us or on behalf of us, hereby agree to release, discharge, hold harmless and indemnify the Parish, the Roman Catholic Diocese of Cleveland, the Bishop of the Roman Catholic Diocese of Cleveland, as well as their respective clergy, officers, employees, agents, representatives, attorneys, sponsors, and volunteers from and against all claims, judgments, liability (of any nature or extent) which in any way arise out of or relate to my child's participation in the program, whether foreseen or unforeseen, regardless of the cause (including, but not limited to, the negligence of any person).
I have read, understand, and agree to the foregiong provision

I have read, understand, and agree to the foregiong provision yes
Parent or Legal Guardian for Student
By signing below, I represent and warrant that I am the parent or legal guardian of the above listed child and have the authority to execute this Agreement on his/her or their behalf and to act on his/her or their behalf.
Type your name in this box
I am the child's *

I am the child's * parent legal guardian
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY
I, the parent or lawful guardian of the ("child”), give permission for my child to participate in the 2023-2024 Confirmation preparation program described further below during the 2023/24 Confirmation Preparation Classes (the "Activity") sponsored by St. Gabriel Parish (the “Parish”). In exchange for and in consideration of the opportunity for my child to participate in the Activity, I agree to the following: 1. I understand what is involved in the Activity and acknowledge that I have had the opportunity to ask questions regarding the scope and nature of the Activity. We will be holding Confirmation Classes at St. Gabriel Catholic School. The address is 9935 Johnnycake Ridge Rd, Mentor OH 44060. Everyone will be in rooms that are air conditioned. Some have area carpets but some do not. There will be use of entire school building including 1st and 2nd floor. Students will be separated at times into groups. 2. I recognize the possibility and risk of injury associated with my child’s participation in the Activity and that such injury can include, but is not limited to, pain, suffering, serious bodily injury, psychological injury, temporary or permanent disability, temporary or permanent paralysis, illness, disfigurement, further injury by medical treatment, and/or death. I understand that such injuries can occur for any number of reasons which are both foreseeable and unforeseeable and which include, but are not limited to, my child’s own actions or inaction, the actions or inaction of others (whether negligent, intentional, or otherwise), and equipment failure. 3. I recognize the possibility and risk of exposure or infection of COVID-19 or other communicable diseases associated with my child’s participation in the Activity and that such exposure or infection may result in my or my child’s or other family members’ exposure to or infection of COVID-19 or other communicable diseases, among other risks, and that such exposure or infection may result in personal injury, illness, permanent disability, death or other damages or expenses. I understand that such exposure or infection can occur for any number of reasons which are both foreseeable and unforeseeable and which include, but are not limited to, my child’s own actions or inaction, the actions or inaction of others (whether negligent, intentional, or otherwise), and equipment failure. 4. I further understand that my Child’s participation in the Activity is purely voluntary and is a privilege and not a right, and that my Child, and I on behalf of my Child, agree to my Child’s participation in the Activity in spite of the risks. I and my spouse assume, for ourselves and on behalf of our minor child(ren), all risks in connection with my child’s participation in the Activity and accept sole responsibility for any injury to such persons including, but not limited to, personal injury, disability, death, illness, damage, loss, claim, liability, or expense, of any kind, that such person(s) may experience or incur in connection with the use of Parish facilities or participation in the Activity . 5. I agree to instruct my child to cooperate with those persons in charge of the activity. I understand and agree that, in the event my child does not cooperate with the person(s) in charge of the activity, which shall be determined at the sole discretion of the person(s) in charge of the activity, I agree to cooperate with the Parish in picking up my child to remove them from the activity. 6. I and my minor child agree to follow and comply with all safety protocols and procedures related to COVID-19 or other communicable diseases that the Parish has adopted or may adopt and which the Parish may from time to time amend. 7. To the fullest extent allowed by law, I, on behalf of myself, my spouse, my minor child, as well as our respective heirs and assigns, executors, all other legal representatives and any others claiming through us or on behalf of us, hereby agree to release, discharge, hold harmless and indemnify the Parish, the Catholic Diocese of Cleveland, the Bishop / Administrator of the Catholic Diocese of Cleveland, as well as their respective clergy, officers, employees, agents, representatives, attorneys, sponsors, and volunteers (“Released Parties”) forever from and against any and all claims, lawsuits, damages, judgments, expenses including attorney’s fees, liabilities (of any nature or extent), demands, damages, cause of action of any nature and kind, known or unknown, which in any way arise out of or relate to my child’s participation in the Activity (including without limitation any injury, loss, or damage to my child’s person or property), whether foreseen or unforeseen, regardless of the cause (including, but not limited to, the negligence of any person) (the “Claims”). 8. To the fullest extent allowed by applicable law, the Agreement shall be binding upon and inure to the benefit of the parties and their respective heirs, administrators, personal representatives, executors, successors and assigns. I, on my behalf and on behalf of my minor child, have the authority to release the Claims and have not assigned or transferred any Claims to any other party. This Agreement constitutes the entire agreement between the parties and supersedes any and all prior oral or written agreements or understandings between the parties concerning the subject matters of this Agreement. This Agreement may not be altered, amended or modified, except by a written document signed by both parties. The Released Parties, to the extent they are not parties to this agreement, are intended to be third party beneficiaries. 9. This acknowledgement and release is intended to be as broad and inclusive as permitted by the law of the State of Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This acknowledgement and release shall be construed in accordance with the laws of the State of Ohio, except for the choice of law provisions thereof. I HAVE CAREFULLY READ AND UNDERSTAND AND ACCEPT THE TERMS AND CONDITIONS STATED HEREIN AND ACKNOWLEDGE THAT THIS PERMISSION, RELEASE AND AUTHORIZATION TO SEEK MEDICAL TREATMENT SHALL BE EFFECTIVE AND BINDING UPON ME, MY CHILD, AND MY OWN AND MY CHILD’S PERSONAL REPRESENTATIVE OR ESTATE, ASSIGNS, HEIRS, AND NEXT OF KIN AND THAT I HAVE SIGNED THIS AGREEMENT OF MY OWN FREE WILL.
Type your name in this box
I am the child's

I am the child's parent legal guardian
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY
Our Confirmation Program will begin in September. Please watch your EMAIL for our calendar. If you have any questions, please call Karen at 352-8282 or kjubeck@st-gabriel.org. Registration deadline is August 1, 2023.

Confirmation Registration Form 2023-24

Confirmation Registration Form 2023-24

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