Daughters of the Immaculate Heart
For girls in grades 5-8
Dates: 3rd Friday of the month, August-April
Time: 7:00-9:00 p.m.
Where: Locations listed below.
Cost: $20
Aug. 26 St. Frances of Rome & magnanimity
Scavenger hunt & archery at Stillwater Reserve
______
Sept. 16 St. Maria Goretti & chastity
Campfire in Father’s backyard
______
Oct. 28 (4th Fri) Bl. Margaret of Castello & compassion
Father/daughter dance at St. Remy Hall
______
Nov. 18 St. Elizabeth of the Trinity & silence
Decoupaging monogram letters in rectory basement
______
Dec. 16 St. Monica & perseverance
Making mason jar cookie gift jars in rectory basement
______
Jan. 20 St. Edith Stein & knowledge
Visiting at Versailles Healthcare Center
______
Feb. 17 St. Margaret Mary Alocoque & meekness
Making Catholic shrines in rectory basement.
______
Mar. 17 St. Mary Magdalene & hope
Tea party & skits in rectory basement
______
Apr. TBA St. Angela Merici & prudence
Bowling at McBo’s
“A woman’s beauty invites,
and if she is virtuous, her
life points to Christ.”
†Dates and activities may change due to availability.
Daughters of the Immaculate Heart Registration Form
Name of child: __________________________________________________________________________
Grade: __________________
Parents’ names: ______________________________________________________________________
This program is not possible without help. We are asking all mothers (or grandmothers, etc.) to take
a turn in helping out at a meeting, as well as contributing to a snack. You will be contacted when
your help is needed. Thank you!
The $20 registration fee helps with the cost of this program which will include activities, rewards
and special snacks.
St. Remy’s will once again be using Flocknote via texting and/or e-mail to send monthly reminders
and needed information.
Please list the preferred cell phone number on which you would like to receive texts:
__________________________________________________________________
Please list the preferred e-mail address you would like us to use as well:
__________________________________________________________________
Please check one:
______ I can be contacted both by texting and e-mail.
______ I do not text. Please use only e-mail.
______ I do not text or have e-mail.
Questions or comments about the program or Flocknote: _________________________________
____________________________________________________________________________________
Please turn in the following by August 24 to the church office:
1. This registration form
2. Emergency medical form (on reverse side)
3. $20 fee
ARCHDIOCESE OF CINCINNATI MEDICAL RELEASE FORM FOR ST REMY’S GIRLS’ GROUPS
PERMISSION, RELEASE AND MEDICAL POWER OF ATTORNEY (rev. 6-2006)
1. I, the lawful parent or guardian of __________________________ (the “child”), give permission for my child to participate in the activity described on the Activity Information form and release from all liability and indemnify the Archbishop of Cincinnati (“the Archbishop”), both individually and as trustee for the Archdiocese of Cincinnati and all parishes within the Archdiocese, and their officers, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost or expenses, including attorney fees, arising out of any injury or illness
incurred by my child while participating in or traveling to or from the activity.
2. I agree to instruct my child to cooperate with the Archbishop or his agents in charge of the activity.
3a. I appoint the Archbishop or his agents who are acting as leaders of the activity as my attorney in fact to act for me in my name and my behalf, in any way that I would act if I were personally present, with respect to the following matters if any injury, illness or medical emergency
occurs during the activity or related travel:
(i) To give any and all consents and authorizations to any physicians, dentist, hospital or other persons or institutions pertaining to any
emergency medications, medical or dental treatments, diagnostic or surgical procedures or any other emergency actions as our
attorney shall deem necessary or appropriate for the best interest of the child.
(ii) I understand that the agents of the Archbishop will make a reasonable attempt to contact me as soon as possible in the event of a
medical emergency involving my child.
3b. This power of attorney shall lapse automatically upon completion of the activity and related travel.
4. I agree that the Archbishop or his agents may use my child’s portrait or photograph for promotional purposes, website and office functions. I
have carefully read this statement, and my signature acknowledges that I fully understand the content and meaning.
Signature of Parent/Guardian ________________________________Date _________
Home Address ______________________________City __________Zip__________
Place of Employment___________________________________________________
Work Address ______________________________City___________Zip__________
Parent or Guardian Phone No. (w)___________________ (h)____________________
Emergency Contact Phone No. (w)_________________ (h)________________
*************************************************************************************************************
Medical Information — Completed by Parent or Guardian — Please Print
Child’s Name _____________________________________Date of birth____________
Child’s Soc. Sec. No. *____________________________
Allergies_______________________________________________________________
Medications____________________________________________________________
Chronic Conditions (e.g. epilepsy, diabetes)___________________________________
Medical Insurance Co. Policy No.___________________________________________
Member’s Name ________________________Phone No. (h)____________ (w)______
Member’s Birth date ____________ Member’s Soc. Sec. No. *____________________
Family Doctor Phone No._______________________________________
*Social Security Number is optional. Please note that some hospitals WILL NOT treat without it.
Activity Information: Sponsored by St. Remy Church, Russia, OH. This on-going activity typically occurs the 3rd Friday of each month (AugApr), in various locations: St. Remy Rectory basement and grounds, Stillwater Prairie Reserve, St. Remy Hall, Versailles Health Care Center,
McBo’s Lanes. . The time is 7-9 pm. Activities include crafts, games, teachings, and prayer. Transportation is not provided. Emergency contact
is Gina Hoying, 937-418-2455.