New Student Registration Form

This form is for new families entering the religious education program at our Parish. Once completed and submitted, the Parish will contact you via email to register your children into the program.

Primary Family Address

Fields with red asterisks are required

Registered Parishioner?

Yes No

Registration in Saint John Chrysostom Parish must precede registration in PREP.

http://www.sjcparish.org/new-parishioner-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

Number of children you will be registering today

How many of those children are in 1 - 7 Grade?

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Father / Guardian

Name

Deceased

Yes No

E-mail

Marital Status

Religion

Cell Phone

Mother / Guardian

Maiden Name

Name

Deceased

Yes No

E-mail

Marital Status

Religion

Cell Phone

Are there any custody/legal issues?

If yes, please provide a complete copy of the latest court order.

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Child 1

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

New Student Returning Student

Class Preference

Session A – Adaptive only Session B – Grades 1-7 only

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2020

School Grade

School Grade in Fall 2020

School

School District

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

*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."

Individualized Education Program (IEP) and/or 504

No Yes

Child 1 Sacraments

First Time Registrants (or Grade 1) need to provide a copy of each child's Baptismal Certificate.

Date of Baptism

Church of Baptism

Church Name, City & State

Previous Religious Education experience / Grade Level Completed

Where

Church Name, City & State

Child 2

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

New Student Returning Student

Class Preference

Session A – Adaptive only Session B – Grades 1-7 only

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2020

School Grade

School Grade in Fall 2020

School

School District

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

*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."

Individualized Education Program (IEP) and/or 504

No Yes

Child 2 Sacraments

First Time Registrants (or Grade 1) need to provide a copy of each child's Baptismal Certificate.

Date of Baptism

Church of Baptism

Church Name, City & State

Previous Religious Education experience / Grade Level Completed

Where

Church Name, City & State

Child 3

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

New Student Returning Student

Class Preference

Session A – Adaptive only Session B – Grades 1-7 only

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2020

School Grade

School Grade in Fall 2020

School

School District

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

*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."

Individualized Education Program (IEP) and/or 504

No Yes

Child 3 Sacraments

First Time Registrants (or Grade 1) need to provide a copy of each child's Baptismal Certificate.

Date of Baptism

Church of Baptism

Church Name, City & State

Previous Religious Education experience / Grade Level Completed

Where

Church Name, City & State

Child 4

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

New Student Returning Student

Class Preference

Session A – Adaptive only Session B – Grades 1-7 only

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2020

School Grade

School Grade in Fall 2020

School

School District

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

*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."

Individualized Education Program (IEP) and/or 504

No Yes

Child 4 Sacraments

First Time Registrants (or Grade 1) need to provide a copy of each child's Baptismal Certificate.

Date of Baptism

Church of Baptism

Church Name, City & State

Previous Religious Education experience / Grade Level Completed

Where

Church Name, City & State

Child 5

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

New Student Returning Student

Class Preference

Session A – Adaptive only Session B – Grades 1-7 only

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2020

School Grade

School Grade in Fall 2020

School

School District

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

*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."

Individualized Education Program (IEP) and/or 504

No Yes

Child 5 Sacraments

First Time Registrants (or Grade 1) need to provide a copy of each child's Baptismal Certificate.

Date of Baptism

Church of Baptism

Church Name, City & State

Previous Religious Education experience / Grade Level Completed

Where

Church Name, City & State

File Uploads

You may upload any documentation (Baptismal Certificate, Custody Info) to us with this upload form.

Add files

Drop files anywhere to add

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Emergency Contact / Doctor

In the case of an emergency, where all attempts at contacting the parent/guardian have failed, we will contact:

Emergency Contact Name

Local contact, other than Parents

Relationship

Emergency Contact Phone

Doctor's Name

Doctor's Phone

Vaccinations

Are your children's vaccinations up to date?

Yes No

If No, has he/she received an exemption from their current school district?

Yes No

Note: Even if you child is exempt from immunizations, he/she may be excluded from school during an outbreak of the vaccine preventable disease.

If No, please explain.

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Program Expectations

To protect the well being and safety of the Staff and students, the students are expected to follow the rules as stated below.

Students are expected to be cooperative, courteous, respectful at all times
Students are expected to respectfully follow all directives given by the catechists and director of the program
Snacks and Gum are not permitted.
Students are expected to be respectful of church and others' property. Students in the Religious Education Program (PREP) are not permitted to handle others' belongings in desks, closets, or classroom in general.
Students are expected to leave the classroom and school property in the condition in which it was found prior to class.

Consistent failure to follow these directives may result in a conference among the Pastor, Director, parents, catechist and student.

Program Expectations

I Agree

Attendance & Other Obligations

We the parents/guardians of the children on this form, realize our obligation as Catholic parents to ensure our child/children’s regular attendance at Religious Education classes in person or zoom and to complete and submit all assigned work as outlined and to follow all guidelines that are set, attend Sunday Mass, and Holy Days of Obligation. We also acknowledge the requirement to attend sacramental meetings, if applicable. We understand that failure to meet these obligations could result in the postponement of our child/children’s reception of the sacraments and/or promotion to the next grade level of their religious studies. We also understand that if we do not attend the monthly in class sessions or zooms we will need to do additional assignments. We understand that no student will be dismissed early without a written note received at the beginning of class start time. We also understand that if a student is picked up within 30 minutes of the start of class, it will be counted as an absence. Participation forms from the previous Summer Session, if applicable, must be completed and submitted to the Director of Religious Education at time of registration for the student to advance to the next grade level.

Attendance & Other Obligations

I Agree

Parent Agreement Form

We the parents/guardians of the children on this form, realize our obligation as Catholic parents to ensure our child/children’s regular attendance at Religious Education classes, Sunday Mass, and Holy Days of Obligation. We also acknowledge the requirement to attend sacramental meetings, if applicable. We understand that failure to meet these obligations could result in the postponement of our child/children’s reception of the sacraments and/or promotion to the next grade level of their religious studies.

We also understand that absences from Religious Education Classes (Grades 1-7 ONLY) are not to exceed three (3) sessions during the 2020-2021 Religious Education Program.

Please note: According to the Archdiocesan policy, excessive absences may result in the inability to advance to the next grade level and delay the reception of one or more sacraments. This determination will be made on a case-by-case basis.

Participation Forms from the previous Summer Session (if applicable) must be completed and submitted to Director of Religious Education to be eligible to re-register.

Parent Agreement Form

I Agree

Catechists / Teacher Volunteer Roles

All volunteers must obtain the clearances required by the Archdiocesan Safe Environment Program

I am willing to be an active participant in my child’s education by

Teaching PREP‎ Serving as a Teacher’s Aide‎ Substituting as a Teacher‎ Substituting as a Teacher’s Aide‎ Serving as a Hall Monitor‎ Crossing Guard on Sundays‎

I am willing to teach on Sundays.

Yes No

Grade(s) I am willing to teach:

Please list

I understand that I must complete the clearance process and submit the forms to Patty Briganti as soon as possible.

Yes

I understand that I must complete the clearance process and submit the forms to Patty Briganti as soon as possible.

Yes

Emergency Medical Release

I give permission for my child(ren) to participate in the St. John Chrysostom Religious Education Program. In case of Medical Emergency, I understand that, in the event medical treatment is required, every effort will be made to contact me or the emergency contact person(s) designated on this form. However, if I cannot be reached, I give permission to the staff to secure the services of a licensed physician to provide the care necessary, including hospitalization, anesthesia, injection, or surgery, for my child’s well-being. I hereby agree to indemnify and hold harmless St. John Chrysostom Catholic Church, the Archdiocese of Philadelphia, and its officers, employees and volunteer staff from any liability.

I agree I disagree

Photo/Video/Social Media Release for 2020-2021

In order to protect the privacy of youth, permission must also be obtained, in writing, from the parent or guardian before sharing/posting pictures or videos of minors.

I give my permission for my child's picture, with name, to be posted on a website or social network page associated with St. John Chrysostom Parish I give my permission for my child's picture, without name, to be posted on a website or social network page associated with St. John Chrysostom Parish I do not give permission for my child's picture to be posted on a website or social network page

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Confidential financial assistance is available. Please note: Your child/children become eligible to attend the first day of PREP after your family's completed registration form and payment have been received.

All information provided has been reviewed and is accurate

Clear

Electronic Signature

Total Choices

Late Fee

Current Date

Please note the fees will increase by $50.00 after July 1, 2019

Total Normal

Your child’s registration is not complete without full payment or the pastor’s approval of financial assistance.

Confidential tuition assistance may be available for families in need. All requests for financial aid require a personal meeting with Fr. Ed as soon as possible. Parents who are seeking financial assistance must contact Fr. Ed for an appointment.

Yes, I am interested in speaking with Fr. Hallinan about the possibility of receiving financial aid. I will contact him prior to Aug 15 to make an appointment. No, I am not interested in seeking financial assistance.

Payment is required at the time of registration. If your family is experiencing financial difficulty and you would like to create a payment plan, please call for an appointment to register in person. Please do not delay in registering due to finances.

Total Amount

All information provided has been reviewed and is accurate.

YES

This form is for new families entering the religious education program at our Parish. Once completed and submitted, the Parish will contact you via email to register your children into the program.

Verification