Student Registration Form

Primary Family Address

Are you registering your children for weekly PREP or Family Catechesis?

PREP Weekly - Catechist-led (weekly at Cold Spring Elementary) Family Catechesis - Parent-led Homeschool

Family Name

Address

Primary E-mail

This will be the main e-mail address we will use to communicate with your family.

Secondary E-mail

Optional second e-mail

Primary Phone

This will be the main phone number we will use to communicate with your family.

Phone Type

Home Cell

Number of Children (PREP - Weekly)

Number of Children you will be registering today

Number of Children (PREP - Family Catechesis)

Number of Children you will be registering today

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Father / Guardian

Name

Living Status

Living Deceased

E-mail

Marital Status

Religion

Cell Phone

Mother / Guardian

Maiden Name

Name

Living Status

Living Deceased

E-mail

Marital Status

Religion

Cell Phone

If there are any custody issues that we need to be aware of, please let us know.

Yes No

Custody Information

If there is a custody agreement please send a copy to the office.

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Please indicate primary spoken and written language of parents and children

English Spanish

In what language would you like to request for your child(ren)'s materials?

English Spanish

Session Choice

Monday Tuesday

Child 1

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

School Grade

Grade this upcoming Fall

School

School District

Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services

Individualized Education Program (IEP)

No Yes

*As defined by Individuals with Disabilities Education Act (IDEA), the term "child with a disability" means a child: "with mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities and who, by reason thereof, needs special education and related services."

Child 1 Sacraments

If registering for first time your Child's Baptismal Certificate must be submitted to the office.

Date of Baptism

If unknown, choose best guess.

Church of Baptism

Church Name, City & State

Date of Reconciliation

Church of Reconciliation

Church Name, City & State

Date of First Communion

Church of First Communion

Church Name, City & State

Child 2

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

School Grade

Grade this upcoming Fall

School

School District

Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services

Individualized Education Program (IEP)

No Yes

*As defined by Individuals with Disabilities Education Act (IDEA), the term "child with a disability" means a child: "with mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities and who, by reason thereof, needs special education and related services."

Child 2 Sacraments

If registering for first time your Child's Baptismal Certificate must be submitted to the office.

Date of Baptism

If unknown, choose best guess.

Church of Baptism

Church Name, City & State

Date of Reconciliation

Church of Reconciliation

Church Name, City & State

Date of First Communion

Church of First Communion

Church Name, City & State

Child 3

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

School Grade

Grade this upcoming Fall

School

School District

Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services

Individualized Education Program (IEP)

No Yes

*As defined by Individuals with Disabilities Education Act (IDEA), the term "child with a disability" means a child: "with mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities and who, by reason thereof, needs special education and related services."

Child 3 Sacraments

If registering for first time your Child's Baptismal Certificate must be submitted to the office.

Date of Baptism

If unknown, choose best guess.

Church of Baptism

Church Name, City & State

Date of Reconciliation

Church of Reconciliation

Church Name, City & State

Date of First Communion

Church of First Communion

Church Name, City & State

Child 4

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

School Grade

Grade this upcoming Fall

School

School District

Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services

Individualized Education Program (IEP)

No Yes

*As defined by Individuals with Disabilities Education Act (IDEA), the term "child with a disability" means a child: "with mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities and who, by reason thereof, needs special education and related services."

Child 4 Sacraments

If registering for first time your Child's Baptismal Certificate must be submitted to the office.

Date of Baptism

If unknown, choose best guess.

Church of Baptism

Church Name, City & State

Date of Reconciliation

Church of Reconciliation

Church Name, City & State

Date of First Communion

Church of First Communion

Church Name, City & State

Child 5

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

School Grade

Grade this upcoming Fall

School

School District

Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services

Individualized Education Program (IEP)

No Yes

*As defined by Individuals with Disabilities Education Act (IDEA), the term "child with a disability" means a child: "with mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities and who, by reason thereof, needs special education and related services."

Child 5 Sacraments

If registering for first time your Child's Baptismal Certificate must be submitted to the office.

Date of Baptism

If unknown, choose best guess.

Church of Baptism

Church Name, City & State

Date of Reconciliation

Church of Reconciliation

Church Name, City & State

Date of First Communion

Church of First Communion

Church Name, City & State

File Upload

Add files

Drop files anywhere to add

Please upload any documents required by the office with this form. (Baptism, Custody, etc.)

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Emergency Contact

Emergency Contact Name

Relationship

Emergency Contact Phone

Terms & Conditions

I understand that in the case of injury or illness, every effort will be made to contact me in a medical emergency. In the event I cannot be reached, I give permission to parish staff to secure all proper and necessary treatment for my child(ren). I understand that no liability is assumed by the church or the Archdiocese for claims that may arise.

I agree

Parental Consent for Medical Care: In case of an emergency, I give permission for my child to receive emergency medical treatment and, if necessary, be transported to the nearest medical facility.

I agree

I understand that photos of my child(ren) may be taken and used in Parish publications including web and print media.

I agree I do not agree

Student Release

In an effort to keep our PREP students safe, all students must be picked up in their classroom by their parent or by a designated driver. The teachers will only release the children to persons whose names appear on the release form.

If for some reason you need some one to pick up your child who is not on the list please send in a hand written note.

I give my permission to have the PREP teacher release my child to the care of the following individuals: (Please include Name and Relationship)

Please print the name of all individuals who have permission to pick up your child. Please include your self, spouse, previous spouse and carpooling friends). Due to some problems with pick up last year sixth graders will also need to be picked up from the classrooms.

Comments/questions/special requests?

Sacramental Fees

Current Date

Late Fee

Registration Fees

Total Amount

Verification