Student Registration Form

Primary Family Information

If you are a registered member of Resurrection parish, the information that you provide here will update your parish registration information.

Family Name

Address

Primary E-mail used to communicate with family

Primary Phone used to communicate with family

Phone Type

Cell Phone Landline

Secondary Contact Name

Relationship to child

Secondary Contact Phone

Other than the primary phone

Phone Type

Cell Phone Landline

Number of Children you are registering today

Are you a REGISTERED member of Resurrection Parish?

Yes No Not registered at any parish

Parish of Registration

If NOT Resurrection Parish

Parish Address

Street, City, State & Zip

Would you like to become a member of Resurrection Parish?

Yes No

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Father / Guardian

Father's Name

Living Status

Living Deceased

E-mail

Marital Status

Religion

Phone

Mother / Guardian

Maiden Name

Mother's Name

Living Status

Living Deceased

E-mail

Marital Status

Religion

Phone

Custody Information

Are there any custody issues we should be made aware of? If there is a custody agreement please bring or mail it to the parish office or use the File Upload at the top of the Terms & Conditions page.

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TUITION FEES

One Child $130 Two Children $200 Three Children (or more) $300

Child 1

Is your child a New or Returning Student to our program?

NEW Student Returning Student

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

School Grade

School Grade in Fall 2021

School

School District

Religious Education Grade

Grade Level 2021-22

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

Characters left: 128/128

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 this child was Baptized at Resurrection Parish (including Holy Name and St. Casimir) or if we have the Baptism Certificate on file, please put an X in the boxes below.

Name of Church or Parish of Baptism

Church or Parish City & State

Baptism Date

If known

You can upload a scanned copy of the Baptism Certificate (if available) at the top of the Terms & Conditions page.

Is this child planning to make Confirmation in 2022 (applies to 8th Grade students)? Where did he/she make First Holy Communion? If Resurrection Parish (including Holy Name and St. Casimir), just put an X in the boxes.

Name of Church or Parish

Church or Parish City & State

Date of First Penance

Only need if sacrament was received

Church or Parish of First Penance

Church Name, City & State

Date of First Eucharist

Only need if sacrament was received

Church or Parish of First Eucharist

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

Is your child a New or Returning Student to our program?

NEW Student Returning Student

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

School Grade

School Grade in Fall 2021

School

School District

Religious Education Grade

Grade Level 2021-22

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

Characters left: 128/128

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 this child was Baptized at Resurrection Parish (including Holy Name and St. Casimir), please put an X in the boxes below.

Name of Church or Parish of Baptism

Church or Parish City & State

Baptism Date

If known

You can upload a scanned copy of the Baptism Certificate (if available) at the top of the Terms & Conditions page.

Is this child planning to make Confirmation in 2022 (applies to 8th Grade students)? Where did he/she make First Holy Communion? If Resurrection Parish (including Holy Name and St. Casimir), just put an X in the boxes.

Name of Church or Parish

Church or Parish City & State

Date of First Penance

Only need if sacrament was received

Church or Parish of First Penance

Church Name, City & State

Date of First Eucharist

Only need if sacrament was received

Church or Parish of First Eucharist

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

Is your child a New or Returning Student to our program?

NEW Student Returning Student

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

School Grade

School Grade in Fall 2021

School

School District

Religious Education Grade

Grade Level 2021-22

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

Characters left: 128/128

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 this child was Baptized at Resurrection Parish (including Holy Name and St. Casimir), please put an X in the boxes below.

Name of Church or Parish of Baptism

Church or Parish City & State

Baptism Date

If known

You can upload a scanned copy of the Baptism Certificate (if available) at the top of the Terms & Conditions page.

Is this child planning to make Confirmation in 2022 (applies to 8th Grade students)? Where did he/she make First Holy Communion? If Resurrection Parish (including Holy Name and St. Casimir), just put an X in the boxes.

Name of Church or Parish

Church or Parish City & State

Date of First Penance

Only need if sacrament was received

Church or Parish of First Penance

Church Name, City & State

Date of First Eucharist

Only need if sacrament was received

Church or Parish of First Eucharist

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

Is your child a New or Returning Student to our program?

NEW Student Returning Student

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

School Grade

School Grade in Fall 2021

School

School District

Religious Education Grade

Grade Level 2021-22

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

Characters left: 128/128

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 this child was Baptized at Resurrection Parish (including Holy Name and St. Casimir), please put an X in the boxes below.

Name of Church or Parish of Baptism

Church or Parish City & State

Baptism Date

If known

You can upload a scanned copy of the Baptism Certificate (if available) at the top of the Terms & Conditions page.

Is this child planning to make Confirmation in 2022 (applies to 8th Grade students)? Where did he/she make First Holy Communion? If Resurrection Parish (including Holy Name and St. Casimir), just put an X in the boxes.

Name of Church or Parish

Church or Parish City & State

Date of First Penance

Only need if sacrament was received

Church or Parish of Reconciliation

Church Name, City & State

Date of First Eucharist

Only need if sacrament was received

Church or Parish of First Eucharist

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

Is your child a New or Returning Student to our program?

NEW Student Returning Student

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

School Grade

School Grade in Fall 2021

School

School District

Religious Education Grade

Grade Level 2021-22

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

Characters left: 128/128

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 this child was Baptized at Resurrection Parish (including Holy Name and St. Casimir), please put an X in the boxes below.

Name of Church or Parish of Baptism

Church or Parish City & State

Baptism Date

If known

You can upload a scanned copy of the Baptism Certificate (if available) at the top of the Terms & Conditions page.

Is this child planning to make Confirmation in 2022 (applies to 8th Grade students)? Where did he/she make First Holy Communion? If Resurrection Parish (including Holy Name and St. Casimir), just put an X in the boxes.

Name of Church or Parish

Church or Parish City & State

Date of First Penance

Only need if sacrament was received

Church or Parish of First Penance

Church Name, City & State

Date of First Eucharist

Only need if sacrament was received

Church or Parish of First Eucharist

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)

Previous Religious Education

Did this child 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

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. Please bring or mail this to the parish office or use the File Upload at the top of the Terms & Conditions page.

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File Upload

Add files

Drop files anywhere to add

You can upload scanned copies of the custody document, Baptism certificate(s), and the required letter(s) from the previous parish/school here.

Terms & Conditions (to be completed ONLY by a parent or legal guardian)

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

To complete this registration, I will provide all required documentation to the parish.

I agree

We need Catechists (free tuition) and Hall Monitors

Would you like to volunteer?

Yes No

If YES, what is your preference?

Catechist Hall Monitor Either

Volunteer Name

Volunteer Phone

Total Choices

Late Fee

Current Date

Total Normal

Tuition Fees - One Child $130 Two Children $200 Three Children $300

Note: A Confirmation Retreat Fee per each 8th grade student will be collected at the time of the retreat.

Total Amount

Electronic Signature of a Parent or Legal Guardian

Clear

Verification