New Student Registration Form

After you complete the New Family Registration application to register for your Parish's Religious Education Program, you will receive an email message from Parish Giving to officially register and pay for Religious Education Classes. Your child will not be assigned to a class without full payment. If your family is experiencing financial difficulty and you would like to create a payment plan, please call the Religious Education Office at 201-529-2294 to make special arrangements. Please do not delay in registering due to finances. Thank you!

Primary Family Address

Family Option

New Family Information Update Existing Family Information

Are you currently registered parishioners of IHMC?

Yes No

If you are not currently registered as parishioners, the information provided in this form will be forwarded to the Rectory and the Parish Office Manager will contact you to finalize your registration.

Family Name

Address

Primary E-mail

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

Primary Phone

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

Number of Children

Number of Children you will be registering today

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Father / Guardian

Father's Name

Living Status

Living Deceased

E-mail

Marital Status

Religion

Cell Phone

We request that one or both parents include a cell phone number that we can use to contact you by phone, and/or to text information about closures, updates and important reminders.

Mother / Guardian

Mother's Name

Maiden Name

Living Status

Living Deceased

E-mail

Marital Status

Religion

Cell Phone

We request that one or both parents include a cell phone number that we can use to contact you by phone, and/or to text information about closures, updates and important reminders.

Custody Information

Are there any custody issues we should be made aware of? If there is a custody agreement please send a copy to the Religious Education Department. If no custody agreement, please indicate N/A

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Schedule of Classes

Grades 1,3, 4 & 5 - Monday, 4:30 p.m. to 5:45 p.m. - Fee: $125.00
Grades 6, 7 & 8 - Monday, 7:00 p.m. to 8:15 p.m. - Fee: $125.00
2nd Grade - First Communion Preparation - Sunday, 10:15 a.m. to 11:45 a.m. - Fee: $150.00
9th Grade - Confirmation Preparation - 2 Sundays/month, 10:15 a.m. to 11:45 a.m. - Fee: $150.00

Fees payable for 1st and 2nd child in each family (3rd or more at no additional charge);
Maximum fee per family $300.00

Child 1

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Date of Baptism

Church of Baptism

Church Name, City & State

Religious Education Grade

Grade in Fall 2019

School Grade

School Grade in Fall 2019

School

School City, State

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

If none, please indicate N/A

Individualized Education Program (IEP)

No Yes

Does Your Child Have An Epi-Pen?

No Yes

Children who require Epi-pens must be able to self-administer. Parents must complete the “Epinephrine Administration Form – Option B” and the "Epinephrine Administration - Physician Form" found on the Parish website. These forms must be renewed on a yearly basis.

Child lives with

Father Mother Both other: ‎

Child 2

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Date of Baptism

Church of Baptism

Church Name, City & State

Religious Education Grade

Grade in Fall 2019

School Grade

School Grade in Fall 2019

School

School City, State

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

If none, please indicate N/A

Individualized Education Program (IEP)

No Yes

Does Your Child Have An Epi-Pen?

No Yes

Children who require Epi-pens must be able to self-administer. Parents must complete the “Epinephrine Administration Form – Option B” and the "Epinephrine Administration - Physician Form" found on the Parish website. These forms must be renewed on a yearly basis.

Child lives with

Father Mother Both other: ‎

Child 3

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Date of Baptism

Church of Baptism

Church Name, City & State

Religious Education Grade

Grade in Fall 2019

School Grade

School Grade in Fall 2019

School

School City, State

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

If none, please indicate N/A

Individualized Education Program (IEP)

No Yes

Does Your Child Have An Epi-Pen?

No Yes

Children who require Epi-pens must be able to self-administer. Parents must complete the “Epinephrine Administration Form – Option B” and the "Epinephrine Administration - Physician Form" found on the Parish website. These forms must be renewed on a yearly basis.

Child lives with

Father Mother Both other: ‎

Child 4

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Date of Baptism

Church of Baptism

Church Name, City & State

Religious Education Grade

Grade in Fall 2019

School Grade

School Grade in Fall 2019

School

School City, State

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

If none, please indicate N/A

Individualized Education Program (IEP)

No Yes

Does Your Child Have An Epi-Pen?

No Yes

Children who require Epi-pens must be able to self-administer. Parents must complete the “Epinephrine Administration Form – Option B” and the "Epinephrine Administration - Physician Form" found on the Parish website. These forms must be renewed on a yearly basis.

Child lives with

Father Mother Both other: ‎

Child 5

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Date of Baptism

Church of Baptism

Church Name, City & State

Religious Education Grade

Grade in Fall 2019

School Grade

School Grade in Fall 2019

School

School City, State

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

If none, please indicate N/A

Individualized Education Program (IEP)

No Yes

Does Your Child Have An Epi-Pen?

No Yes

Children who require Epi-pens must be able to self-administer. Parents must complete the “Epinephrine Administration Form – Option B” and the "Epinephrine Administration - Physician Form" found on the Parish website. These forms must be renewed on a yearly basis.

Child lives with

Father Mother Both other: ‎

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Emergency Contact / Doctor

Emergency Contact Name

Relationship

Emergency Contact Phone

Doctor's Name

Doctor's Phone

Child Pick up Information

Who will pick up the children?

Mother‎ Father‎ Other...‎

Other Name 1

Relationship

Step Father, Grandparent, Aunt, Uncle, Friend, etc.

Other Phone 1

Other Name 2

Relationship

Step Father, Grandparent, Aunt, Uncle, Friend, etc.

Other Phone 2

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 appropriate 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 disagree

Volunteer Phone

Total Cap

Total Choices

Convenience Fee

Late Fee

Current Date

An additional fee of $25.00 will be added on August 1, 2019.

Total Normal

Coupon Code

Coupon Code Discount

Sub Total

Payment is required at the time of registration. Your child will not be assigned to a class without full payment. If your family is experiencing financial difficulty and you would like to create a payment plan, please call for an appointment to register in person. Please do not delay in registering due to finances.

Now that you have completed the New Family Registration application to register for your Parish's Religious Education Program, you will receive an email message from Parish Giving to officially register and pay for Religious Education Classes. Thank you!

Total Amount

Maximum Fee Per Family: $300.00

Verification