Student Registration Form

A donation is requested at time of registration but not required. Suggested amount is $10 for per child or $25 for a family of 3 or more children.

Primary Family Address

Are you a member of our Parish?

Yes No

If NO, What is your 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

Name

Deceased

Yes No

Maiden Name

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.

Children live with

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Child 1

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2021

School Grade

School Grade in Fall 2021

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 an intellectual disability, 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

Sunday 8:00-8:45 am (Grades PreK-8) Monday 6:30-8:00 pm (Grades 9-10)

I understand weekly Mass attendance is an integral part of faith formation. My family will attend Mass weekly.

Child 2

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2021

School Grade

School Grade in Fall 2021

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 an intellectual disability, 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

Sunday 8:00-8:45 am (Grades PreK-8) Monday 6:30-8:00 pm (Grades 9-10)

I understand weekly Mass attendance is an integral part of faith formation. My family will attend Mass weekly.

Child 3

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2021

School Grade

School Grade in Fall 2021

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 an intellectual disability, 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

Sunday 8:00-8:45 am (Grades PreK-8) Monday 6:30-8:00 pm (Grades 9-10)

I understand weekly Mass attendance is an integral part of faith formation. My family will attend Mass weekly.

Child 4

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2021

School Grade

School Grade in Fall 2021

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 an intellectual disability, 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

Sunday 8:00-8:45 am (Grades PreK-8) Monday 6:30-8:00 pm (Grades 9-10)

I understand weekly Mass attendance is an integral part of faith formation. My family will attend Mass weekly.

Child 5

Name

Gender

Male Female

Date of Birth

Place of Birth

City & State

Religious Education Grade

Grade in Fall 2021

School Grade

School Grade in Fall 2021

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 an intellectual disability, 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

Sunday 8:00-8:45 am (Grades PreK-8) Monday 6:30-8:00 pm (Grades 9-10)

I understand weekly Mass attendance is an integral part of faith formation. My family will attend Mass weekly.

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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Immunization

Are all of your child(ren)s vaccinations up to date?

Yes No

If no, have they received an exemption from your current school district?

Yes No

Even if your child is exempt from immunizations, he/she may be excluded from school during an outbreak of the vaccine preventable disease.

If no, please explain

Emergency Contact

Emergency Contact Name 1

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

Relationship

Emergency Contact Phone 1

Emergency Contact Name 2

Relationship

Emergency Contact Phone 2

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 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 St. John's church or the diocese of Syracuse 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 Permission Required Under the Direction of the Syracuse Diocese - I grant permission to St. John the Evangelist Church to use photos of myself or child for use in the Church Bulletin, Church Bulletin Boards, St. John’s Web Site or Newspaper

I agree I disagree

St. John’s Safe Environment Class Information for Parents

The annual safe environment training for the Diocese of Syracuse will take place in our faith formation classes during the 2021-2022 year. The lessons are all available at www.syrdio.org. The overall theme is that God created us and loves us. Topics at different grade levels include how to keep safe, adults to ask for help, bullying, how to deal with bullying, internet safety, building good relationships.

My child(ren) has permission to participate in the safe environment class.

I agree I disagree

Sacramental Fees

Volunteer Discount

Additional Fee

Current Date

Subtotal

A donation is requested at time of registration but not required. Suggested amount is $10 for per child or $25 for a family of 3 or more children.

I wish to make a donation.

Yes No

Donation

Total Amount

You will now be directed to a payment page. Payment can be made by credit/debit card or bank transfer. Please note: Registration will not be complete without payment.

Verification