Youth

Child and Youth Protection

Our Lady of Mercy is committed to providing a safe environment for children. The parish adheres to the diocesan Child Protection Program which includes certification and registration of all adults seeking to work with minors in our Parish. Diocesan Requirements for Certification to Work With Minors:  All employees and volunteers working in positions deemed to have ongoing, unsupervised contact with minors in diocesan parishes and schools must first complete the Child Protection Requirements. Click here to access the website of the B.R. Diocese, Office of Child and Youth Protection. On the left side of the page “EAPPS Volunteer Application” to complete the form.

Child Protection Requirements

Complete an EAPPS Application
Submit to a criminal background screening
Complete Safe and Sacred online training
Code of Ethics: Read, sign, and return forms to the Church Office
(Please Note: on the “Declarations Page” (page 3) you must INITIAL each statement)

Contact Information

Ms. Ashley Umberger

Administrative Assistant

(225) 924-1054
aumberger@olomschool.org

CHILD PROTECTION FORMS

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RCIC Registration Form 2016-17

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Our Lady of Mercy Parish RCIC Registration 2016-2017

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The fee is $30 per student or $60 per family. Please complete the Registration Form, and have your credit card ready for payment. Thank you.

OLOM Church/School may publish photographs of your child(ren) *
Yes
No

Part I - Student's Information

(Must be completed for EACH student enrolling)

First Name *

Middle Name *

Last Name *

Sex *
Male
Female

Place of Birth

City *

State *

Grade Entering 2016-2017 Year *

School of Enrollment

Child Attends OLOM Extended Day

Child 2 First Name

Middle Name

Child 2 Last Name

Sex
Male
Female

Place of Birth

City

State

Grade Entering 2016-2017 Year

School of Enrollment

Attends OLOM Extended Day

Child 3 First Name

Child 3 Last Name

Sex
Male
Female

Place of Birth

City

State

Grade Entering 2016-2017 Year

School of Enrollment

Attends OLOM Extended Day

Child 4 First Name

Child 4 Last Name

Sex
Male
Female

Place of Birth

City

State

Grade Entering 2016-2017 Year

School of Enrollment

Attends OLOM Extended Day

Part II - Parent's Information

(Must be completed for EACH student enrolling)

Student Lives With
Both Parents
Mother
Father
Mother & Stepfather
Father & Stepmother
Grandparents

Send All Mailings To*

First Name *

Last Name *

Address *

City *

State *

Zip / Post Code *

Mother's Information

Mother's First Name *

Mother's Last Name *

Mother's Maiden Name

Home Phone *

Cell Phone

Work Phone

Email *

Mother's Occupation

Mother's Religion

Are you registered with OLOM Church

Father's Information

Father's First Name *

Father's Last Name *

Home Phone *

Cell Phone

Work Phone

Email

Father's Occupation

Father's Religion

Are you registered with OLOM Church

Emergency Contact

Emergency Contact First Name *

Emergency Contact Last Name *

Phone *

We are here to support you in the Christian education of your child and are most concerned about meeting the needs of each student. Therefore, please note any special needs or situations in your child's life, or in the life of your family that his/her religion teacher should know. All information will be held in the strictest confidence. This knowledge could save embarrassment for your child during the course of the year, and will increase the effectiveness of our teachers (i.e. learning problems, separation, divorce, remarriage, recent death in family, etc).

Interests

Why does your child want to become Catholic?

Who or what played a significant role in the decision to become a Catholic?

$30 Registration per student or $60 per family
One Child
Family

Total

Card Number The (typically) 16 digits on the front of your credit card.

CVC The 3 digit (back) or 4 digit (front) value on your card.

Name on the card The name printed on the front of your credit card.

Expiration month (MM) The month your credit card expires, typically on the front of the card.

Expiration year (YYYY) The year your credit card expires, typically on the front of the card.

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Pilgrimage of Mercy

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The major relics of St. Maria Goretti will be displayed at Our Lady of Mercy on the Eve of All Saints Day through All Saints Day of this year. Please consider making a gift to help defray the cost of the pilgrimage to our parish.

If you have questions or need help with this form, please email Ms. Deanie Smith, or call her (225) 926-1883. After entering your personal information and the amount(s), you will be directed to a secure website for the Donation/Credit Card Process. Please have your credit card information ready.

First Name *

Last Name *

Address *

City *

State *

Zip / Post Code *

Phone *

Email *

Pilgrimage of Mercy Donation Amount *

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Holy Name Society Form

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First Name *

Last Name *

Email *

Phone *

Comment

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Mercy Greeters Ministry Form

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Sign up here for the Greeters Ministry. Greeters assist periodically with distribution and/or of materials to those attending masses.

First Name *

Last Name *

Address *

City *

State *

Zip / Post Code *

Phone *

Email *

Mass Preference(s)

Saturday, 4 PM

Saturday, 6 PM

Sunday, 7 AM

Sunday, 9 AM

Sunday, 10:30 AM

Sunday, 12 NOON

Sunday, 6 PM

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Life Teen Registration Form

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The $50 registration fee covers a t-shirt and food for Life Nights.

OLOM Church may publish photographs of your child
Yes
No

Part I - Teen Specifics

Teen First Name *

Teen Last Name *

Gender *
Male
Female

T-Shirt Size

Address *

City *

State *

Teen Cell Phone *

Teen Email *

School of Enrollment *

Grade Entering 2016-2017 Year *

Part II - Parent's Information

(Must be completed for EACH student enrolling)

Mother's Information

Mother's First Name *

Mother's Last Name *

Home Phone *

Cell Phone

Mother's email *

Father's Information

Father's First Name *

Father's Last Name *

Home Phone *

Cell Phone

Father's email *

Emergency Contact

First Name *

Last Name *

Phone *

Special Needs (if applicable). Describe any allergy, chronic illness, or other conditions:

Parents - Are you interested in chaperoning events? *

Parents - Are you interested in providing a meal for Life Nights? *

$50 Registration per teen *
Registration

Total

Card Number The (typically) 16 digits on the front of your credit card.

CVC The 3 digit (back) or 4 digit (front) value on your card.

Name on the card The name printed on the front of your credit card.

Expiration month (MM) The month your credit card expires, typically on the front of the card.

Expiration year (YYYY) The year your credit card expires, typically on the front of the card.

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Evening Bible Study Form

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First Name *

Last Name *

Address *

City *

State *

Zip / Post Code *

Phone *

Email *

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Site Feedback

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Youth

Child and Youth Protection

Child Protection Requirements

Contact Information

Ms. Ashley Umberger

Administrative Assistant

Church

School

Parish Activity Center