New Student Registration Form

Primary Family Address

This is a data form only. After this has been processed you will receive an email from Parish Giving to register for PREP.

Are you volunteering as a catechist?

No Yes

If Yes, what is code word given to you by the DRE?

Are you a registered parishioner of Saint Eleanor Parish?

Yes No

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

Please look for an email from Parish Giving with information on registering your child(ren) for PREP classes.

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Father / Guardian

Name

E-mail

Marital Status

Religion

Cell Phone

Deceased

Yes No

Mother / Guardian

Maiden Name

Name

E-mail

Marital Status

Religion

Cell Phone

Deceased

Yes No

Custody Information

Yes No

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

Child 1 Name

Child 1 Gender

Male Female

Child 1 Date of Birth

Child 1 Place of Birth

City & State

Child 1 Religious Education Level

What PREP Level will your child be this upcoming Fall?

Child 1 School Grade

School Grade this upcoming Fall

Child 1 School

Child 1 School District

Child 1 Sacraments

Child 1 Date of Baptism

Child 1 Church of Baptism

Church Name, City & State

Has your child received his or her First Holy Eucharist?

Yes No

Has your child received his or her Confirmation?

Yes No

Child 1 Additional Information

Child 1 Medical Conditions/Allergies

Please list any medical conditions/allergies (food, gluten, asthma) your child may have at present.

Child 1 Prescribed Medications

Child 1 Disability / Learning Support

Does your child require additional Learning Support Services, other than a typical classroom-learning environment?

Child 1 Individualized Education Program (IEP)

No Yes

Does your child have an Individualized Education Program (IEP) in place at school?

Child 2

Child 2 Name

Child 2 Gender

Male Female

Child 2 Date of Birth

Child 2 Place of Birth

City & State

Child 2 Religious Education Level

What PREP Level will your child be this upcoming Fall?

Child 2 School Grade

School Grade this upcoming Fall

Child 2 School

Child 2 School District

Child 2 Sacraments

Child 2 Date of Baptism

Child 2 Church of Baptism

Church Name, City & State

Has your child received his or her First Holy Eucharist?

Yes No

Has your child received his or her Confirmation?

Yes No

Child 2 Additional Information

Child 2 Medical Conditions/Allergies

Please list any medical conditions/allergies (food, gluten, asthma) your child may have at present.

Child 2 Prescribed Medications

Child 2 Disability / Learning Support

Does your child require additional Learning Support Services, other than a typical classroom-learning environment?

Child 2 Individualized Education Program (IEP)

No Yes

Does your child have an Individualized Education Program (IEP) in place at school?

Child 3

Child 3 Name

Child 3 Gender

Male Female

Child 3 Date of Birth

Child 3 Place of Birth

City & State

Child 3 Religious Education Level

What PREP Level will your child be this upcoming Fall?

Child 3 School Grade

School Grade this upcoming Fall

Child 3 School

Child 3 School District

Child 3 Sacraments

Child 3 Date of Baptism

Child 3 Church of Baptism

Church Name, City & State

Has your child received his or her First Holy Eucharist?

Yes No

Has your child received his or her Confirmation?

Yes No

Child 3 Additional Information

Child 3 Medical Conditions/Allergies

Please list any medical conditions/allergies (food, gluten, asthma) your child may have at present.

Child 3 Prescribed Medications

Child 3 Disability / Learning Support

Does your child require additional Learning Support Services, other than a typical classroom-learning environment?

Child 3 Individualized Education Program (IEP)

No Yes

Does your child have an Individualized Education Program (IEP) in place at school?

Child 4

Child 4 Name

Child 4 Gender

Male Female

Child 4 Date of Birth

Child 4 Place of Birth

City & State

Child 4 Religious Education Level

What PREP Level will your child be this upcoming Fall?

Child 4 School Grade

School Grade this upcoming Fall

Child 4 School

Child 4 School District

Child 4 Sacraments

Child 4 Date of Baptism

Child 4 Church of Baptism

Church Name, City & State

Has your child received his or her First Holy Eucharist?

Yes No

Has your child received his or her Confirmation?

Yes No

Child 4 Additional Information

Child 4 Medical Conditions/Allergies

Please list any medical conditions/allergies (food, gluten, asthma) your child may have at present.

Child 4 Prescribed Medications

Child 4 Disability / Learning Support

Does your child require additional Learning Support Services, other than a typical classroom-learning environment?

Child 4 Individualized Education Program (IEP)

No Yes

Does your child have an Individualized Education Program (IEP) in place at school?

Child 5

Child 5 Name

Child 5 Gender

Male Female

Child 5 Date of Birth

Child 5 Place of Birth

City & State

Child 5 Religious Education Level

What PREP Level will your child be this upcoming Fall?

Child 5 School Grade

School Grade this upcoming Fall

Child 5 School

Child 5 School District

Child 5 Sacraments

Child 5 Date of Baptism

Child 5 Church of Baptism

Church Name, City & State

Has your child received his or her First Holy Eucharist?

Yes No

Has your child received his or her Confirmation?

Yes No

Child 5 Additional Information

Child 5 Medical Conditions/Allergies

Please list any medical conditions/allergies (food, gluten, asthma) your child may have at present.

Child 5 Prescribed Medications

Child 5 Disability / Learning Support

Does your child require additional Learning Support Services, other than a typical classroom-learning environment?

Child 5 Individualized Education Program (IEP)

No Yes

Does your child have an Individualized Education Program (IEP) in place at school?

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Emergency Contact

Emergency Contact Name

Relationship

Emergency Contact Phone

Family Physician

Family Physician's Phone

Insurance Company

Policy Number

Group Number

Terms & Conditions

General Permission Statement
I hereby give my child permission to participate in all St. Eleanor Parish programs and their components.

Medical and Emergency Release
In the event my child becomes ill, is injured, or requires medical attention of any kind, and I cannot be reached by telephone, I hereby authorize the Saint Eleanor Religious Education staff to make the necessary decisions concerning emergency treatment. I also give permission for my child to be transported to the nearest medical facility or hospital for treatment.

Photographic Release
By signing below, the parent or guardian gives permission and waives the right to any type of compensation for their child to be photographed or video taped at any or all activities sponsored by the P.R.E.P. program or the parish. Pictures or videos may be used for educational or publicity purposes. I also understand that Masses and retreats may be livestreamed and posted to parish website and social media, that classes may utilize synchronous remote learning such as Zoom or Google Classroom and that professional photography service may be obtained to document Holy Communion and Confirmation Masses.

I accept the above Terms & Conditions

I agree

Are you interested in learning more about becoming a volunteer in our PREP program?

Yes No

If you are qualified to receive tuition assistance would you be interested in receiving information about Holy Cross Regional Catholic School?

Yes No

Total Choices

Total Normal

Now that you have completed the application to register for Saint Eleanor’s Religious Education Program, you will receive an e-mail message from Parish Giving to officially register and pay for Religious Education Classes. Thank you!

Verification