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Family Information
Primary Family Information
Family Name
Address
Primary E-mail used to communicate with family
Primary Phone used to communicate with family
Phone Type
Cell Phone
Landline
Number of Children you are registering today
1
2
3
4
5
Are you a member of Resurrection Parish?
Yes
No
Parish of Registration
If NOT Resurrection Parish
Parish Address
Street, City, State & Zip
Did your children attend a different Parish Program/Catholic School last year?
Yes
No
Previous Parish Name / Catholic School
If NOT Resurrection Parish
Address
Street, City, State & Zip
If yes, we need the name and address of the Parish/Catholic School. A letter is required from the previous parish/school indicating the Religious Education grade completed.
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Father / Guardian
Name
Living Status
Living
Deceased
E-mail
Marital Status
Married
Divorced
Separated
Single
Widower
Religion
Phone
Mother / Guardian
Maiden Name
Name
Living Status
Living
Deceased
E-mail
Marital Status
Married
Divorced
Separated
Single
Widower
Religion
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
One Child $130 Two Children $200 Three Children (or more) $300
CLASS TIMES:
Sunday (Grades K-4)
Sunday (Grades 5-8)
Child 1
Name
Gender
Male
Female
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 2018-19
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
School Grade in Fall 2018
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, Holy Name or St. Casimir)
Date of Baptism
Church or Parish of Baptism
Church Name, City & State
Date of Reconciliation
Only need if sacrament was received
Church or Parish of Reconciliation
Church Name, City & State
Date of First Communion
Only need if sacrament was received
Church or Parish of First Communion
Church Name, City & State
Date of Confirmation
Only need if sacrament was received
Church or Parish of Confirmation
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
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 2018-19
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
School Grade in Fall 2018
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, Holy Name or St. Casimir)
Date of Baptism
Church or Parish of Baptism
Church Name, City & State
Date of Reconciliation
Only need if sacrament was received
Church or Parish of Reconciliation
Church Name, City & State
Date of First Communion
Only need if sacrament was received
Church or Parish of First Communion
Church Name, City & State
Date of Confirmation
Only need if sacrament was received
Church or Parish of Confirmation
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
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 2018-19
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
School Grade in Fall 2018
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, Holy Name or St. Casimir)
Date of Baptism
Church or Parish of Baptism
Church Name, City & State
Date of Reconciliation
Only need if sacrament was received
Church or Parish of Reconciliation
Church Name, City & State
Date of First Communion
Only need if sacrament was received
Church or Parish of First Communion
Church Name, City & State
Date of Confirmation
Only need if sacrament was received
Church or Parish of Confirmation
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
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 2018-19
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
School Grade in Fall 2018
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, Holy Name or St. Casimir)
Date of Baptism
Church or Parish of Baptism
Church Name, City & State
Date of Reconciliation
Only need if sacrament was received
Church or Parish of Reconciliation
Church Name, City & State
Date of First Communion
Only need if sacrament was received
Church or Parish of First Communion
Church Name, City & State
Date of Confirmation
Only need if sacrament was received
Church or Parish of Confirmation
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
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 2018-19
School Grade
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
School Grade in Fall 2018
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, Holy Name or St. Casimir)
Date of Baptism
Church or Parish of Baptism
Church Name, City & State
Date of Reconciliation
Only need if sacrament was received
Church or Parish of Reconciliation
Church Name, City & State
Date of First Communion
Only need if sacrament was received
Church or Parish of First Communion
Church Name, City & State
Date of Confirmation
Only need if sacrament was received
Church or Parish of Confirmation
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
Emergency Contact Name
Relationship to child
Emergency Contact Phone
Phone Type
Cell Phone
Landline
Optional Emergency Contact Phone 2
Phone Type
Cell Phone
Landline
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, 2018
Total Amount
Verification
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SUBMIT FORM AND PAY
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