| St. John Vianney Catholic Church

VERSO Registration

Family Information

Address: REQUIRED Please fill out this field. 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.

Father's 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.

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.

Mother's 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.

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.

Emergency Contact

Other Medical Treatment: In the event it comes to the attention of the SJV Middle School Team (VERSO), that your child becomes ill with symptoms such as headache, vomiting, sore throat, diarrhea, you will be called. If we are unable to contact you, the emergency contact person listed below will be contacted.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

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

Relationship to Child REQUIRED Please fill out this field. Please enter valid data.

Permission and Liability

We, as parents/guardians of the minor(s) whom we are registering for St. John Vianney's Middle School Ministry (VERSO), for the 2022-2023 school year, hereby consent and agree to hold harmless St. John Vianney Parish and/or the Roman Catholic Diocese of Lafayette-in-Indiana, Inc., and any and all employees or volunteers thereof, for any accident, injury or occurrence arising out of, or in connection with the aforementioned activity.

I Agree Please select this field.

Media and SJV Web Page Acknowledgement

We believe that both the youth and the Parish benefit from positive recognition. There may be occasions for media coverage including your student throughout the year, through shared video or pictures.

***No names will be used***

This could include, but not be limited to:
Public Media: Newspaper, TV, Catholic Moment, other public media
Church Media: Bulletin Boards, Parish Videos, Newsletters, other church media
Web Based Media: Parish Web site, Other related ministry and religious web sites, social meda
By checking the box "I agree", below you are indicating your permission and consent.

I Agree Please select this field.

Student Information

Safe Environment Committment

The Diocese of Lafayette-in-Indiana, as well as St. John Vianney Catholic Church, is committed to protecting our young people. We require all staff and adult volunteers to have a current background check on file, and to be certified in our diocesan provided, and mandated, Safe and Sacred Training program. Please contact the parish office at 485-0150, for more details on how to receive the training, or check to see if yours is still current (valid for three years).

St. John Vianney
Catholic Church, Fishers, IN

A Pastorate of the Diocese of Lafayette-in-Indiana

VERSO Registration

Family Information

Permission and Liability

Media and SJV Web Page Acknowledgement

Student Information

Safe Environment Committment