Student Registration Form

Primary Family Address

Are you a member of our Parish?

Yes No

If NO, What is you current parish?

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.

1 child $85.00 // 2 children $95.00 // 3+ children $100.00 until 7/15/2021

Number of Children

Number of Children you will be registering today

Number of Children (Alternate Pricing)

Number of Children you will be registering today

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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

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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File Uploads

Upload all of your children's Baptismal Certificate here

Add files

Drop files anywhere to add

Child 1

Check all that apply to this Child

My child has not yet been baptized.‎ My child has not yet received First Holy Communion.‎ My child is registering for the first time.‎ My child's Baptismal Certificate is attached above.‎ My child is re-registering as a returning Student.‎

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Septemeber

School Grade

School Grade in September

School

School District

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."

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

New Student Returning Student

Child 1 Sacraments

Previous Religious Education Experience

Please provide student's last grade completed and Parish Name / Address

If registering for first time your Child's Baptismal Certificate must be submitted to the office.

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 1 Session Choice

Grades 1-10 - Every Other Sunday in person - 9:00-10:20 AM

Students are required to attend Mass with their family during the regular weekend schedule.

There are additional materials fees for older students preparing to receive Sacraments

*Students in grades 3 or higher who have NOT RECEIVED FIRST HOLY COMMUNION will also be enrolled in “Communion for older students Classes” one Sunday a month for 2 years. Dates: TBD.

**Students who are 7 years old or older who have NOT BEEN BAPTIZED will be enrolled in a special RCIA class one Sunday a month, to prepare for Baptism, Communion and Confirmation. The amount of preparation time will vary according to the child’s understanding.

***Students Preparing for Confirmation will also be enrolled in “Confirmation Preparation Program” one Sunday a month, for 2 years.

Does this child qualify for for one of these options?

Yes No

Additional $10.00 fee for this extra textbook.

Child 2

Check all that apply to this Child

My child has not yet been baptized.‎ My child has not yet received First Holy Communion.‎ My child is registering for the first time.‎ My child's Baptismal Certificate is attached above.‎ My child is re-registering as a returning Student.‎

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in September

School Grade

School Grade in September

School

School District

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."

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

New Student Returning Student

Child 2 Sacraments

Previous Religious Education Experience

Please provide student's last grade completed and Parish Name / Address

If registering for first time your Child's Baptismal Certificate must be submitted to the office.

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 Session Choice

Grades 1-10 - Every Other Sunday in person - 9:00-10:20 AM

Students are required to attend Mass with their family during the regular weekend schedule.

There are additional materials fees for older students preparing to receive Sacraments

*Students in grades 3 or higher who have NOT RECEIVED FIRST HOLY COMMUNION will also be enrolled in “Communion for older students Classes” one Sunday a month for 2 years. Dates: TBD.

**Students who are 7 years old or older who have NOT BEEN BAPTIZED will be enrolled in a special RCIA class one Sunday a month, to prepare for Baptism, Communion and Confirmation. The amount of preparation time will vary according to the child’s understanding.

***Students Preparing for Confirmation will also be enrolled in “Confirmation Preparation Program” one Sunday a month, for 2 years.

Does this child qualify for for one of these options?

Yes No

Additional $10.00 fee for this extra textbook.

Child 3

Check all that apply to this Child

My child has not yet been baptized.‎ My child has not yet received First Holy Communion.‎ My child is registering for the first time.‎ My child's Baptismal Certificate is attached above.‎ My child is re-registering as a returning Student.‎

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in September

School Grade

School Grade in September

School

School District

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."

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

New Student Returning Student

Child 3 Sacraments

Previous Religious Education Experience

Please provide student's last grade completed and Parish Name / Address

If registering for first time your Child's Baptismal Certificate must be submitted to the office.

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 Session Choice

Grades 1-10 - Every Other Sunday in person - 9:00-10:20 AM

Students are required to attend Mass with their family during the regular weekend schedule.

There are additional materials fees for older students preparing to receive Sacraments

*Students in grades 3 or higher who have NOT RECEIVED FIRST HOLY COMMUNION will also be enrolled in “Communion for older students Classes” one Sunday a month for 2 years. Dates: TBD.

**Students who are 7 years old or older who have NOT BEEN BAPTIZED will be enrolled in a special RCIA class one Sunday a month, to prepare for Baptism, Communion and Confirmation. The amount of preparation time will vary according to the child’s understanding.

***Students Preparing for Confirmation will also be enrolled in “Confirmation Preparation Program” one Sunday a month, for 2 years.

Does this child qualify for for one of these options?

Yes No

Additional $10.00 fee for this extra textbook.

Child 4

Check all that apply to this Child

My child has not yet been baptized.‎ My child has not yet received First Holy Communion.‎ My child is registering for the first time.‎ My child's Baptismal Certificate is attached above.‎ My child is re-registering as a returning Student.‎

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in September

School Grade

School Grade in September

School

School District

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."

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

New Student Returning Student

Child 4 Sacraments

Previous Religious Education Experience

Please provide student's last grade completed and Parish Name / Address

If registering for first time your Child's Baptismal Certificate must be submitted to the office.

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 Session Choice

Grades 1-10 - Every Other Sunday in person - 9:00-10:20 AM

Students are required to attend Mass with their family during the regular weekend schedule.

There are additional materials fees for older students preparing to receive Sacraments

*Students in grades 3 or higher who have NOT RECEIVED FIRST HOLY COMMUNION will also be enrolled in “Communion for older students Classes” one Sunday a month for 2 years. Dates: TBD.

**Students who are 7 years old or older who have NOT BEEN BAPTIZED will be enrolled in a special RCIA class one Sunday a month, to prepare for Baptism, Communion and Confirmation. The amount of preparation time will vary according to the child’s understanding.

***Students Preparing for Confirmation will also be enrolled in “Confirmation Preparation Program” one Sunday a month, for 2 years.

Does this child qualify for for one of these options?

Yes No

Additional $10.00 fee for this extra textbook.

Child 5

Check all that apply to this Child

My child has not yet been baptized.‎ My child has not yet received First Holy Communion.‎ My child is registering for the first time.‎ My child's Baptismal Certificate is attached above.‎ My child is re-registering as a returning Student.‎

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in September

School Grade

School Grade in September

School

School District

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."

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

New Student Returning Student

Child 5 Sacraments

Previous Religious Education Experience

Please provide student's last grade completed and Parish Name / Address

If registering for first time your Child's Baptismal Certificate must be submitted to the office.

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 Session Choice

Grades 1-10 - Every Other Sunday in person - 9:00-10:20 AM

Students are required to attend Mass with their family during the regular weekend schedule.

There are additional materials fees for older students preparing to receive Sacraments

*Students in grades 3 or higher who have NOT RECEIVED FIRST HOLY COMMUNION will also be enrolled in “Communion for older students Classes” one Sunday a month for 2 years. Dates: TBD.

**Students who are 7 years old or older who have NOT BEEN BAPTIZED will be enrolled in a special RCIA class one Sunday a month, to prepare for Baptism, Communion and Confirmation. The amount of preparation time will vary according to the child’s understanding.

***Students Preparing for Confirmation will also be enrolled in “Confirmation Preparation Program” one Sunday a month, for 2 years.

Does this child qualify for for one of these options?

Yes No

Additional $10.00 fee for this extra textbook.

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Emergency Contact

Emergency Contact Name

Relationship

Emergency Contact Phone

Volunteer Information

Will you be volunteering?

Yes No

Volunteer Name

Volunteer Phone

Volunteer Interested in

Teacher Assistant Teacher Hall Monitor

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Terms & Conditions

I/we have read the attached program goals and expectations and we will support them.

Yes

I/we understand that the tuition covers books, materials and activities and so I will pay in full at time of registration.

Yes

I/we understand that our child’s picture may be used in the Religious Education Calendar and other promotional materials.

Yes

Total Cap

Registration + Book Fees

Late Fee

Current Date

Total Normal

Total Amount

Payment must be made in full at the time of registration.

Verification