Student Registration Form

Grades 1 & 3 - 8

Homeschool

Grade 2
Homeschool with 2 person classes

Grade 9
4 Mini Retreats

Registration Fee: $ 20.00
Sacramental fee: $5.00 (Grades 2 and 9 only)

A Processing Fee of $2.00 will be added to cover the processing costs.

Late fee of $5.00 will be added for all registrations received after September 30, 2020

You must be a registered parishioner at either church

to attend religious education classes at St. Kevin

Are you registered member of the parish?

Yes, Saint Kevin Yes, Saint Benedict No

Registration will be confirmed with the parish secretary

St. Kevin budget #

St. Benedict budget #

Your family must be registered parishioners of St. Kevin or St. Benedict to attend religious education classes at St. Kevin. The registration form can be found on St. Kevin website. www.stkevin-stbenedict.org

Primary Family Address

Family Name

On Budget Envelope

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

Discount code

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Birth Father

Name

Deceased

Yes No

E-mail

Marital Status

Religion

Cell Phone

Home Phone

Birth Mother

Maiden Name

Name

Deceased

Yes No

E-mail

Marital Status

Religion

Cell Phone

Home Phone

Guardian / Step Parent

Name

leave blank if none

E-mail

Marital Status

Religion

Cell Phone

Home Phone

The Children reside with

Father‎ Mother‎ other: ‎

Choose all that apply

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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Child 1

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

New Student Returning Student

Name

Gender

Male Female

Baptismal / Birth name (if different from above)

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2020

School Grade

School Grade in Fall 2020

School Attending

Last Grade of Religious Education attended

Where did your child attend Religious Education Classes last year?

Parish address and phone number

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."

Child 1 Sacraments

Has baptismal certificate been given to office? If not, please use the upload form below to send it to us. Please note: Baptisms performed at St. Kevin remain on file and no certificate is necessary.

Baptized?

Yes No

Date of Baptism

Church of Baptism

Church Name, City & State

Reconciliation?

Yes No

Date of Reconciliation

Church of Reconciliation

Church Name, City & State

First Communion?

Yes No

Date of First Communion

Church of First Communion

Church Name, City & State

Child 1 Session Choice

Grades 1-8 - Sundays 8:50am - 9:50am

Child 2

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

New Student Returning Student

Name

Gender

Male Female

Baptismal / Birth name (if different from above)

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2020

School Grade

School Grade in Fall 2020

School Attending

Last Grade of Religious Education attended

Where did your child attend Religious Education Classes last year?

Parish address and phone number

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."

Child 2 Sacraments

Has baptismal certificate been given to office? If not, please use the upload form below to send it to us. Please note: Baptisms performed at St. Kevin remain on file and no certificate is necessary.

Baptized?

Yes No

Date of Baptism

Church of Baptism

Church Name, City & State

Reconciliation?

Yes No

Date of Reconciliation

Church of Reconciliation

Church Name, City & State

First Communion?

Yes No

Date of First Communion

Church of First Communion

Church Name, City & State

Child 2 Session Choice

Grades 1-8 - Sundays 8:50am - 9:50am

Child 3

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

New Student Returning Student

Name

Gender

Male Female

Baptismal / Birth name (if different from above)

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2020

School Grade

School Grade in Fall 2020

School Attending

Last Grade of Religious Education attended

Where did your child attend Religious Education Classes last year?

Parish address and phone number

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."

Child 3 Sacraments

Has baptismal certificate been given to office? If not, please use the upload form below to send it to us. Please note: Baptisms performed at St. Kevin remain on file and no certificate is necessary.

Baptized?

Yes No

Date of Baptism

Church of Baptism

Church Name, City & State

Reconciliation?

Yes No

Date of Reconciliation

Church of Reconciliation

Church Name, City & State

First Communion?

Yes No

Date of First Communion

Church of First Communion

Church Name, City & State

Child 3 Session Choice

Grades 1-8 - Sundays 8:50am - 9:50am

Child 4

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

New Student Returning Student

Name

Gender

Male Female

Baptismal / Birth name (if different from above)

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2020

School Grade

School Grade in Fall 2020

School Attending

Last Grade of Religious Education attended

Where did your child attend Religious Education Classes last year?

Parish address and phone number

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."

Child 4 Sacraments

Has baptismal certificate been given to office? If not, please use the upload form below to send it to us. Please note: Baptisms performed at St. Kevin remain on file and no certificate is necessary.

Baptized?

Yes No

Date of Baptism

Church of Baptism

Church Name, City & State

Reconciliation?

Yes No

Date of Reconciliation

Church of Reconciliation

Church Name, City & State

First Communion?

Yes No

Date of First Communion

Church of First Communion

Church Name, City & State

Child 4 Session Choice

Grades 1-8 - Sundays 8:50am - 9:50am

Child 5

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

New Student Returning Student

Name

Gender

Male Female

Baptismal / Birth name (if different from above)

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2020

School Grade

School Grade in Fall 2020

School Attending

Last Grade of Religious Education attended

Where did your child attend Religious Education Classes last year?

Parish address and phone number

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."

Child 5 Sacraments

Has baptismal certificate been given to office? If not, please use the upload form below to send it to us. Please note: Baptisms performed at St. Kevin remain on file and no certificate is necessary.

Baptized?

Yes No

Date of Baptism

Church of Baptism

Church Name, City & State

Reconciliation?

Yes No

Date of Reconciliation

Church of Reconciliation

Church Name, City & State

First Communion?

Yes No

Date of First Communion

Church of First Communion

Church Name, City & State

Child 5 Session Choice

Grades 1-8 - Sundays 8:50am - 9:50am

For New Students: A copy of baptismal certificate must be submitted before child can attend classes.You can upload a copy here or have the Church of Baptism fax a copy over to 732-2832 ATTN Religious Education

Add files

Drop files anywhere to add

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Emergency Contact

Emergency Contact Name

Relationship

Emergency Contact Phone

In case of emergency, what hospital should your child be sent to?

Volunteer Information

Will you be volunteering?

Yes No

Volunteer Name

Volunteer Phone

Volunteer Interested in

Teacher Assistant Teacher

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St. Kevin/St. Benedict Religious Education Policies Grade 9

Attending Mass and receiving the Eucharist is an important part of our Catholic faith. Parents, we humbly ask for your partnership in teaching your children the importance of Mass by bringing them to Church.

Online registration must be completed and paid in full before the first retreat. If any information or baptismal certificates are missing, parents will be contacted for corrections. Corrections must be received before your child can attend class.

A late fee of $5.00 will be assessed for any registration received after Septmeber 30, 2020.

St. Kevin/St. Benedict Religious Education Policies Grades 1-8

Attending Mass and receiving the Eucharist is an important part of our Catholic faith. Parents, we humbly ask for your partnership in teaching your children the importance of Mass by bringing them to Church.

After four homeschool assignments not being turned in, a meeting with DRE will be required. This may result in your child repeating the grade.

Online registration must be completed and paid in full before starting homeschooling. If any information or baptismal certificates are missing, parents will be contacted for corrections. Corrections must be received before your child can receive materials to begin homeschooling.

A late fee of $5.00 will be assessed for any registration received after Septmeber 30, 2020.

I agree to the above policies

I agree

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 I disagree

Total Choices

Late Fee

Processing Fee

Discount

Current Date

A Late Fee of $5.00 will be added after September 30, 2020

Total Normal

Total Amount

Verification