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Family Address
Primary Family Address
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
Are you a member of Resurrection Parish?
Yes
No
Parish of Registration
If NOT Resurrection Parish
Parish Address
Street, City, State & Zip
Did you children attend a different Parish Program/Catholic School last year?
Yes
No
Parish Program/Catholic School attended last year, if not Resurrection (letter is needed from previous parish)
Previous Parish Name / Catholic School
If NOT Resurrection Parish
Address
Street, City, State & Zip
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Father / Guardian
Name
Living Status
Living
Deceased
E-mail
Marital Status
Married
Divorced
Separated
Single
Widower
Religion
Cell Phone
Mother / Guardian
Maiden Name
Name
Living Status
Living
Deceased
E-mail
Marital Status
Married
Divorced
Separated
Single
Widower
Religion
Cell Phone
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.
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TUITION FEES:
Tuition Fees - One Child $130 Two Children $200 Three Children (or more) $300
CLASS TIMES:
Sunday 11:15am - 12:30pm (Grades K-4)
Wednesday 6:45 - 8:00pm (Grades 5-8)
Child 1
Name
Gender
Male
Female
Email
Date of Birth
Place of Birth
City & State
Religious Education Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Grade Level 2017-18
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
School Grade in Fall 2017
School
School District
Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services
Does your child have medication that needs to be carried/administered during PREP? Are there any other special instructions? (i.e. dismissal, transportation, etc.)
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. (not necessary if baptized at Resurrection Parish)
Date of Baptism
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
Is this child Baptized in another Christian Faith - Profession of Faith to Catholic if Baptized in another Faith - Full Initiation, RCIA (Baptized after age 7)
Child 2
Name
Gender
Male
Female
Email
Date of Birth
Place of Birth
City & State
Religious Education Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Grade Level 2017-18
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
School Grade in Fall 2017
School
School District
Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services
Does your child have medication that needs to be carried/administered during PREP? Are there any other special instructions? (i.e. dismissal, transportation, etc.)
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. (not necessary if baptized at Resurrection Parish)
Date of Baptism
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
Is this child Baptized in another Christian Faith - Profession of Faith to Catholic if Baptized in another Faith - Full Initiation, RCIA (Baptized after age 7)
Child 3
Name
Gender
Male
Female
Email
Date of Birth
Place of Birth
City & State
Religious Education Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Grade Level 2017-18
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
School Grade in Fall 2017
School
School District
Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services
Does your child have medication that needs to be carried/administered during PREP? Are there any other special instructions? (i.e. dismissal, transportation, etc.)
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. (not necessary if baptized at Resurrection Parish)
Date of Baptism
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
Is this child Baptized in another Christian Faith - Profession of Faith to Catholic if Baptized in another Faith - Full Initiation, RCIA (Baptized after age 7)
Child 4
Name
Gender
Male
Female
Email
Date of Birth
Place of Birth
City & State
Religious Education Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Grade Level 2017-18
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
School Grade in Fall 2017
School
School District
Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services
Does your child have medication that needs to be carried/administered during PREP? Are there any other special instructions? (i.e. dismissal, transportation, etc.)
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. (not necessary if baptized at Resurrection Parish)
Date of Baptism
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
Is this child Baptized in another Christian Faith - Profession of Faith to Catholic if Baptized in another Faith - Full Initiation, RCIA (Baptized after age 7)
Child 5
Name
Gender
Male
Female
Email
Date of Birth
Place of Birth
City & State
Religious Education Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Grade Level 2017-18
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
School Grade in Fall 2017
School
School District
Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services
Does your child have medication that needs to be carried/administered during PREP? Are there any other special instructions? (i.e. dismissal, transportation, etc.)
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. (not necessary if baptized at Resurrection Parish)
Date of Baptism
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
Is this child Baptized in another Christian Faith - Profession of Faith to Catholic if Baptized in another Faith - Full Initiation, RCIA (Baptized after age 7)
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Emergency Contact / Doctor
Emergency Contact Name
Relationship
Emergency Contact Phone
Emergency Contact 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
Volunteer Information
Will you be volunteering?
Yes
No
Volunteer Name
Volunteer Phone
Volunteer Interested in
Teacher
Assistant Teacher
Hall Monitor
Total Cap
Total Choices
Late Fee
Late Fee Date
Total Normal
Tuition Fees - One Child $130 Two Children $200 Three Children $300
A Late Fee of $25.00 will be added after August 31, 2017
Total Amount
Verification
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SUBMIT FORM AND PAY