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.

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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PLEASE ATTACH THE FOLLOWING TO THIS REGISTRATION FORM: (Upload form below)

COPY OF EACH CHILD'S BAPTISMAL CERTIFICATE
IF MOVING FROM ANOTHER PARISH PROGRAM, A LETTER FROM THE PASTOR OR DIRECTOR OF RELIGIOUS EDUCATION STATING THAT THEY HAVE ATTENDED CLASSES THERE.

**ALL REGISTERING FOR LEVEL 2 OR LEVEL 8 MUST HAVE COMPLETED THE FIRST YEAR OF PREPARATION IN THE TWO-YEAR REQUIREMENT FOR THE SACRAMENTS OF EUCHARIST AND CONFIRMATION.

Child 1

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2018

School Grade

School Grade in Fall 2018

School

School District

Individualized Education Program (IEP)

No Yes

Please list all pertinent medical/learning data so we can best meet the needs of your child. (Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services)

Medical/Learning Data

*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

Is your child going to use our Home Study program?

Yes No

I understand weekly Mass attendance is required to remain in the Home Study program as well as attendance at the designated parent workshops. Failure to attend weekly Mass/Workshops will result in child being moved to the Classroom session.

Child 1 Home Study

Choice1 Choice3 Choice2

Child 1 Session Choice

Choice1 Choice2 Choice3

Child 2

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2018

School Grade

School Grade in Fall 2018

School

School District

Individualized Education Program (IEP)

No Yes

Please list all pertinent medical/learning data so we can best meet the needs of your child. (Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services)

Medical/Learning Data

*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

Is your child going to use our Home Study program?

Yes No

I understand weekly Mass attendance is required to remain in the Home Study program as well as attendance at the designated parent workshops. Failure to attend weekly Mass/Workshops will result in child being moved to the Classroom session.

Child 2 Home Study

Choice1 Choice3 Choice2

Child 2 Session Choice

Choice1 Choice2 Choice3

Child 3

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2018

School Grade

School Grade in Fall 2018

School

School District

Individualized Education Program (IEP)

No Yes

Please list all pertinent medical/learning data so we can best meet the needs of your child. (Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services)

Medical/Learning Data

*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

Is your child going to use our Home Study program?

Yes No

I understand weekly Mass attendance is required to remain in the Home Study program as well as attendance at the designated parent workshops. Failure to attend weekly Mass/Workshops will result in child being moved to the Classroom session.

Child 3 Home Study

Choice1 Choice3 Choice2

Child 3 Session Choice

Choice1 Choice2 Choice3

Child 4

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2018

School Grade

School Grade in Fall 2018

School

School District

Individualized Education Program (IEP)

No Yes

Please list all pertinent medical/learning data so we can best meet the needs of your child. (Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services)

Medical/Learning Data

*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

Is your child going to use our Home Study program?

Yes No

I understand weekly Mass attendance is required to remain in the Home Study program as well as attendance at the designated parent workshops. Failure to attend weekly Mass/Workshops will result in child being moved to the Classroom session.

Child 4 Home Study

Choice1 Choice3 Choice2

Child 4 Session Choice

Choice1 Choice2 Choice3

Child 5

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2018

School Grade

School Grade in Fall 2018

School

School District

Individualized Education Program (IEP)

No Yes

Please list all pertinent medical/learning data so we can best meet the needs of your child. (Medical Conditions/Allergies - Prescribed Medications - Disability*/Learning Support Services)

Medical/Learning Data

*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

Is your child going to use our Home Study program?

Yes No

I understand weekly Mass attendance is required to remain in the Home Study program as well as attendance at the designated parent workshops. Failure to attend weekly Mass/Workshops will result in child being moved to the Classroom session.

Child 5 Home Study

Choice1 Choice3 Choice2

Child 5 Session Choice

Choice1 Choice2 Choice3

Document Uploads

File Uploads

Add files

Drop files anywhere to add

Please upload any documents required by the office with this form. (Baptism, Custody, etc.)

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Emergency Contact / Doctor

Emergency Contact Name

If we are unable to contact a parent in the event of an emergency, whom should we contact?

Relationship

Emergency Contact Phone

Doctor's Name

Doctor's Phone

Volunteer Information

Will you be volunteering?

Yes No

Volunteer Name

Volunteer Phone

Volunteer Interested in

Teacher Assistant Teacher Hall Monitor

Catecist Code

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Terms & Conditions

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

Photo and Walking Permission

Over the course of the school year, the children may have opportunities to attend prayer services or other activities, which may take place in the church. The catechists will accompany the children at these times. Also, we would like to share photos of special events with local newspapers and the Catholic Star Herald.

I give permission for my child/children to walk with their class to St. Joseph Church during Religious Education hours.

I also give permission for my child/children, to be photographed during St. Joseph Religious Education class or related activities and for those photos to be published in the Catholic Star Herald and other area publications.

Photo and Walking Permission

I agree

Discount

Total Choices

Additional Fee

Current Date

An additional fee of $25.00 will be added after August 31, 2018

Total Normal

Payment is required at the time of registration. Your child will not be assigned to a class without full payment.

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

Verification