New Student Registration Form

PLEASE NOTE - Only a child's parent or legal guardian is to complete this online application form. We cannot accept forms completed by a non-parent or non-legal guardian.

Welcome! This is a NEW FAMILY application for Saint Eleanor'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.

The program consists of three components for public school students in Levels 1 through 7.

The P.R.E.P. level corresponds to the child’s grade level UNLESS a prior P.R.E.P. level has been missed or he/she has not received the prior sacraments.

For any questions, please contact Teri Lahey, Director, at tlahey@steleanor.com or 610-489-4677. Thank you!

Take the Plunge one-week summer program registration, Levels 1 - 6, will open January 21, 2020 and close March 20, 2020. Summer Program runs from June 22 through June 26, 2020. The pricing for the one-week summer option is $250 per child. Click here to view the requirements of the program. Registration will be open to all Parish families. ** Please note that there is also a $30 Sacrament material fee for Level 2.

Family Option registration, Levels 1 - 6, will open after Take the Plunge registration closes. Click here to view the requirements of the program. The pricing for the Family Option is as follows:

One Child ~ $100
Two Children ~ $150
Three Children ~ $175
Four Children ~ $200

**Please note that there is also a $30 Sacrament material fee for Level 2.

Sacrament of Confirmation registration for Level 7 students will open in April 2020. This year, there is no tuition fee for Level 7 students. There will be a Sacrament of Confirmation material fee of $65, which will cover retreat, robe, and certificate. More details about registration will be forthcoming.

Primary Family Address

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

Number of Children

Catechists: Number of Children you will be registering today

In order to ensure your child's placement in your choosen workshop, payment must be made in full.

Page Break

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.

Page Break

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 in the Fall of 2020?

Child 1 School Grade

School Grade in Fall 2020

Child 1 School

Child 1 School District

Child 1 Sacraments

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

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 in the Fall of 2020?

Child 2 School Grade

School Grade in Fall 2020

Child 2 School

Child 2 School District

Child 2 Sacraments

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

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 in the Fall of 2020?

Child 3 School Grade

School Grade in Fall 2020

Child 3 School

Child 3 School District

Child 3 Sacraments

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

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 in the Fall of 2020?

Child 4 School Grade

School Grade in Fall 2020

Child 4 School

Child 4 School District

Child 4 Sacraments

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

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 in the Fall of 2020?

Child 5 School Grade

School Grade in Fall 2020

Child 5 School

Child 5 School District

Child 5 Sacraments

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

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?

Page Break

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 religious education classes, Confirmation P.R.E.P., the G.I.F.T. Program, and all other trips and programs sponsored by Saint Eleanor Parish for the program year.

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 professional photography services may be obtained to document the First Holy Communion Masses and the 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

Total Choices

Total Normal

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

Yes No

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