St Mary's Church, Washingtonville, NY
New Family Religious Education 2019-2020
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Family Address
Welcome! This is a
NEW FAMILY application
for St. Mary’s Church, Washingtonville, NY's Parish Religious Education Program. Once you have completed the application, you will receive an e-mail from
Parish Giving
to register and pay for Religious Education Classes.
Primary Family Address
Family Name
Physical Address
Mailing Address
Primary E-mail
This will be the main e-mail address we will use to communicate with your family.
Primary Cell Phone
Primary Home Phone
Number of Children
1
2
3
4
5
Number of Children you will be registering today
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If any field is not applicable please enter N/A
Father / Guardian
Name
Deceased
Yes
No
E-mail
Marital Status
Married
Divorced
Separated
Single
Widower
Religion
Cell Phone
Date of Birth
Occupation
Mother / Guardian
Name
Deceased
Yes
No
Maiden Name
E-mail
Marital Status
Married
Divorced
Separated
Single
Widow
Religion
Cell Phone
Date of Birth
Occupation
Marriage Information
Date of Marriage
Church/Place of Marriage Address
Other Family Members
Step Parent
Religion
Date of Birth
Other Household Members not listed on this form
Include Name / Birth date / Religion
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Child 1
Name
Baptismal Name
Gender
Male
Female
Date of Birth
Place of Birth
City & State
Religious Education Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Grade in Fall 2019
School Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
School Grade in Fall 2019
School
School District
Child lives with
Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services
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."
Religious Education Grade Completed
Prior Rel Education Church/Address
Child 1 Sacraments
Baptismal certificate needed for new students unless baptized at St. Mary’s. Certificates may be faxed to 845-496-3159. Child will be placed on class list only after receipt of certificate. A letter of transfer or last report card is required for new students level 2 and up.
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
Child 2
Name
Baptismal Name
Gender
Male
Female
Date of Birth
Place of Birth
City & State
Religious Education Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Grade in Fall 2019
School Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
School Grade in Fall 2019
School
School District
Child lives with
Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services
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."
Religious Education Grade Completed
Prior Rel Education Church/Address
Child 2 Sacraments
Baptismal certificate needed for new students unless baptized at St. Mary’s. Certificates may be faxed to 845-496-3159. Child will be placed on class list only after receipt of certificate. A letter of transfer or last report card is required for new students level 2 and up.
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
Child 3
Name
Baptismal Name
Gender
Male
Female
Date of Birth
Place of Birth
City & State
Religious Education Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Grade in Fall 2019
School Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
School Grade in Fall 2019
School
School District
Child lives with
Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services
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."
Religious Education Grade Completed
Prior Rel Education Church/Address
Child 3 Sacraments
Baptismal certificate needed for new students unless baptized at St. Mary’s. Certificates may be faxed to 845-496-3159. Child will be placed on class list only after receipt of certificate. A letter of transfer or last report card is required for new students level 2 and up.
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
Child 4
Name
Gender
Male
Female
Date of Birth
Place of Birth
City & State
Religious Education Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Grade in Fall 2019
School Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
School Grade in Fall 2019
School
School District
Child lives with
Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services
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."
Religious Education Grade Completed
Prior Rel Education Church/Address
Child 4 Sacraments
Baptismal certificate needed for new students unless baptized at St. Mary’s. Certificates may be faxed to 845-496-3159. Child will be placed on class list only after receipt of certificate. A letter of transfer or last report card is required for new students level 2 and up.
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
Child 5
Name
Baptismal Name
Gender
Male
Female
Date of Birth
Place of Birth
City & State
Religious Education Grade
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Grade in Fall 2019
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 2019
School
School District
Child lives with
Medical/Learning Data: Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services
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."
Religious Education Grade Completed
Prior Rel Education Church/Address
Child 5 Sacraments
Baptismal certificate needed for new students unless baptized at St. Mary’s. Certificates may be faxed to 845-496-3159. Child will be placed on class list only after receipt of certificate. A letter of transfer or last report card is required for new students level 2 and up.
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 there anything else we should know about your child/children that would better enable us to minister to him/her?
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Emergency Contact
Emergency Contact Name 1
Relationship
Emergency Contact Phone
Emergency Contact Name 2
Person other than parents
Relationship
Emergency Contact Phone
Volunteer Information
Will you be volunteering?
Yes
No
Volunteer Name
Volunteer Phone
Volunteer Interested in
Teacher
Assistant Teacher
Hall Monitor
So we can apply your volunteer discount, how many children did you register today?
1
2
3
4
5
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Terms & Conditions
If I cannot be reached, I give permission for my child to receive emergency medical attention at the nearest hospital.
I agree
I disagree
Unless I notify the religious education in writing otherwise, I grant St. Mary’s parish permission to use, for promotional purposes only, any photograph, video, or audio footage captured during my child’s participation in any religious-education/youth group-related activity. This includes the child’s likeness or thoughts expressed during a church-sponsored event. Promotional material may include, but not be limited to, vehicles such as the parish website, social media or hard-copy publication such as the parish bulletin.
I agree
I disagree
Total Cap
Total Choices
Late Fee
Current Date
A Late Fee of $25.00 will be added after August 31, 2018
Total Normal
Total Amount
Now that you have completed the New Family Registration application to register for ST. Mary’s Church, Washingtonville, NY’s Religious Education Program, you will receive an email message from Parish Giving to officially register and pay for Religious Education Classes. Thank you!
Verification
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SUBMIT FORM