2026-2027 Our Lady's Childcare Registration

Our Lady's Childcare is provided in a safe, clean, and friendly space in OLA's Education & Formation Building. Children play with toys and games and enjoy fellowship while in our programs.

Effective dates: June 1, 2026 - May 31, 2027

Ages: 6 months - 11 years

Information provided in this form will only be available to OLA staff, including childcare workers.

Child Information

Child Name

Birthdate

Gender

Female Male

Address

Phone

Photo of Child for staff use only

Upload (8MB)

Is it ok for your child to have Goldfish during childcare?

Yes No

FOOD allergies & dietary restrictions (describe allergy, reactions, seriousness & management). Please type NONE if child has NO allergies.

Medical conditions, physical restrictions, learning challenges, behavioral conditions or social concerns. Please type NONE if child has no special medical or social conditions.

Is i

Yes No

Parent/Guardian 1 Info

This should be the parent / guardian / conservator who will primarily be responsible for bringing and picking up the child.

P1 First Name

P1 Last Name

P1 Cell Phone

P1 Email

This address will receive a confirmation email

Parent/Guardian 2 or other Emergency Contact

This person also has the right or permission to pick up the child.

P2 First Name

P2 Last Name

P2 Cell Phone

P2 Email

Emergency Contact #3

This adult also has permission to pick up the child.

EC3 First Name

EC3 Last Name

EC3 Cell Phone

EC3 Email

Consent to Participate and Liability Release

I / We, the parent(s)/guardian(s)/conservator(s) of the child listed on this form grant permission for my son/daughter to participate in all childcare activities and functions. I understand that as parent/guardian/conservator, I remain legally responsible for any personal actions taken by my son/daughter. I/ We recognize the inherent risk associated with childcare activities that my son/daughter will be participating in. I/ We agree on behalf of myself, my son/daughter named herein, my heirs, successors, and assigns to indemnify, defend, and hold harmless Our Lady of Angels Parish and the Roman Catholic Diocese of Dallas, their employees and/or volunteers from any and all claims (unless due to the Sole or Gross NEGLIGENCE of the Parish) for illness, injury, death, and the cost of medical treatment therewith, arising from or in any way connected with my son/daughter participating and/or attending childcare programs and activities during this year noted above. In the event any legal action is taken by either party against the other party to enforce any of the terms and conditions of this release, it is agreed that the unsuccessful party to such action shall pay to the prevailing party therein all reasonable court costs, reasonable attorneys’ fees and expenses incurred by the prevailing party.

I have read this consent & liability release, & I understand & voluntarily agree to its provisions.

Authorization of Consent to Treat a Minor

I/We, are the parent(s) &/or guardians of the child listed above, a minor, and as such do hereby authorize Our Lady of Angels, its employees, contractors and volunteers as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician or surgeon licensed under the laws of the jurisdiction where such diagnosis or treatment may be given, whether such diagnosis or treatment is rendered at the office of said physician, at a hospital, or at any other location. It is understood that this authorization is given in advance of any specific treatment or diagnosis, but is given to provide authority and power of treatment, or hospital care which the aforementioned physician in the exercise of best judgment may deem advisable. This authorization is given pursuant to the provisions of Chapter 32 of the Texas Family Code. This authorization shall remain effective throughout the specific dates listed on this form. In consideration of acceptance of this authorization, but without any time limitation and without any future right of revocation, I/we hereby release, defend and hold harmless the Parish and Roman Catholic Diocese of Dallas (Diocese), their officers, directors, agents, employees, volunteers, and contractors from all claims, liabilities and loss in any way arising out of or in connection with or relating to such treatment and treatment decisions.

I have read this consent to treat statement, & I understand & voluntarily agree to its provisions.

Media Consent & Social Media Communications

On occasion, video recordings, audio recordings, photographic slides, and photographs are taken of children and youth during church and diocesan sponsored activities. These are utilized in newsletters, websites, event promotion, advertisements and other printed media. As the State of Texas does not prevent audio or video recording or the photographing of children/youth for good and valuable consideration, I hereby grant to Our Lady of Angels Catholic Church the irrevocable and unrestricted right to make, use and/or publish any and all photographs, videos, and other images of me/my minor child or images in which children may be included, now existing or hereafter made, in any case, with or without identifying the child for editorial, advertising, news, or any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same. On behalf of myself and/or my child, I specifically waive all rights to privacy and confidentiality with respect to name, likeness, voice, photographs, images, video recordings, audio recordings and identifying information. I hereby release and agree to fully and unconditionally protect, indemnify, and defend Our Lady of Angels, the Roman Catholic Diocese of Dallas, and their respective officers, agents, and employees, (collectively, “Indemnitees”) and hold each Indemnitee harmless from and against any and all costs, expenses, attorney’s fees, claims damages, demands, suits, judgments, losses, or liability for injuries to property, injuries to persons (including Student) and from any other costs, expenses, attorney fees, claims, suits judgments, losses, or liabilities of any and every nature whatsoever arising in any manner, directly or indirectly, out of, in connection with, in the course of, or incidental to the use or publication of any photographs, videos, or other images of Student, REGARDLESS OF CAUSE OR OF THE JOINT, COMPARATIVE, OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES. If you wish to opt out the participating child or discuss any part of this media release, please email Anne Ledbetter at childcare@ourladyofangels.com.

I have read this consent for Media Release, & I understand and voluntarily agree to its provisions or I will email childcare@ourladyofangels.com to opt out.

Electronic Signature for Agreements

Name of Person giving above consents

Relationship to Participant

Parent/Legal Guardian Other

Electronic Signature of initials w/ Date of Birth, Last 4-Digits of Social Security Number or other unique ID

Questions or Comments for Our Lady's Childcare Coordinator

2026-2027 Our Lady's Childcare Registration

Description

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