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Immaculate Heart of Mary, Mahwah, NJ
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Family Address
Schedule of Classes
September 2020-May 2021
Grades 1,3-8 - Fee: $125.00
2nd Grade - First Communion - Fee: $150.00
9th Grade - Confirmation Candidates - Fee: $150.00
Maximum charge per family $300.00
Note: If your family is experiencing financial difficulty and you would like to defer payment, check that box at the end of the registration form. Please do not delay in registering due to finances. Thank you!
Please Choose One
Our child(ren) will participate in the hybrid program.
Our child(ren) will participate in the home school program.
Primary Family Address
Family Option
New Family Information
Update Existing Family Information
Are you currently registered parishioners of IHMC?
Yes
No
All families are expected to be registered and supportive members of Immaculate Heart of Mary Parish. 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
1
2
3
4
5
Number of Children you will be registering today
Page Break
Father / Guardian
Father's Name
Living Status
Living
Deceased
E-mail
Marital Status
Married
Divorced
Separated
Single
Widower
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
Married
Divorced
Separated
Single
Widow
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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Page Break
Child 1
Name
Gender
Male
Female
Date of Birth
Place of Birth
City & State
Child lives with
Father
Mother
Both
other:
Date of Baptism
Baptismal Certificate required for first time registration.
Church of Baptism
Church Name, City & State
Religious Education Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Confirmation
Grade in Fall 2020
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
School Grade in Fall 2020
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
Parents of children whose allergies require them to carry Epi-pens must comply with Archdiocese of Newark Guidelines regarding their use. The required forms are available on the parish website, and must be completed and returned to the Religious Education Office in order for these children to be allowed to attend class. These forms must be renewed on a yearly basis.
Child 2
Name
Gender
Male
Female
Date of Birth
Place of Birth
City & State
Child lives with
Father
Mother
Both
other:
Date of Baptism
Baptismal Certificate required for first time registration.
Church of Baptism
Church Name, City & State
Religious Education Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Confirmation
Grade in Fall 2020
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
School Grade in Fall 2020
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
Parents of children whose allergies require them to carry Epi-pens must comply with Archdiocese of Newark Guidelines regarding their use. The required forms are available on the parish website, and must be completed and returned to the Religious Education Office in order for these children to be allowed to attend class. These forms must be renewed on a yearly basis.
Child 3
Name
Gender
Male
Female
Date of Birth
Place of Birth
City & State
Child lives with
Father
Mother
Both
other:
Date of Baptism
Baptismal Certificate required for first time registration.
Church of Baptism
Church Name, City & State
Religious Education Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Confirmation
Grade in Fall 2020
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
School Grade in Fall 2020
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
Parents of children whose allergies require them to carry Epi-pens must comply with Archdiocese of Newark Guidelines regarding their use. The required forms are available on the parish website, and must be completed and returned to the Religious Education Office in order for these children to be allowed to attend class. These forms must be renewed on a yearly basis.
Child 4
Name
Gender
Male
Female
Date of Birth
Place of Birth
City & State
Child lives with
Father
Mother
Both
other:
Date of Baptism
Baptismal Certificate required for first time registration.
Church of Baptism
Church Name, City & State
Religious Education Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Confirmation
Grade in Fall 2020
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
School Grade in Fall 2020
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
Parents of children whose allergies require them to carry Epi-pens must comply with Archdiocese of Newark Guidelines regarding their use. The required forms are available on the parish website, and must be completed and returned to the Religious Education Office in order for these children to be allowed to attend class. These forms must be renewed on a yearly basis.
Child 5
Name
Gender
Male
Female
Date of Birth
Place of Birth
City & State
Child lives with
Father
Mother
Both
other:
Date of Baptism
Baptismal Certificate required for first time registration.
Church of Baptism
Church Name, City & State
Religious Education Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Confirmation
Grade in Fall 2020
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
School Grade in Fall 2020
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
Parents of children whose allergies require them to carry Epi-pens must comply with Archdiocese of Newark Guidelines regarding their use. The required forms are available on the parish website, and must be completed and returned to the Religious Education Office in order for these children to be allowed to attend class. These forms must be renewed on a yearly basis.
Epi-pen forms can be found on the website at
https://ihmcmahwah.org/religious-education
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Page Break
Emergency Contact
Emergency Contact Name
Relationship
Emergency Contact 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
I have read the IHMC Religious Education Parent Handbook and agree to the requirements of the program, including the Code of Conduct.
I have read and agree to the rules of the
parent handbook
.
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
Current Date
Total Cap
Total Choices
Convenience Fee
Late Fee
Total Normal
Coupon Code
Coupon Code Discount
Sub Total
Please select a payment option, verify and click on “Submit Form and Pay.” You will be redirected to the Parish Giving website, where you may pay by credit card or electronic check.
If you have chosen to pay by cash or check, or to defer payment, once you are redirected to the Parish Giving website, be assured that your child(ren)’s information has been successfully submitted. You will be contacted shortly by the Parish Catechetical Leader to make arrangements. Please do not delay in registering due to finances. Thank you!
Payment Options
Pay in Full Now.
Will Pay by Cash or Check (payable to IHMC Religious Education).
Need to defer payment; would like to discuss.
Total Amount
Maximum Fee Per Family: $300.00
Verification
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SUBMIT FORM AND PAY
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