REGISTRATION FORM – RETURN NO LATER THAN AUGUST 24TH
2009-2010 SCHOOL YEAR
FAMILY LAST
NAME____________________________________________PHONE_________________________
STREET
ADDRESS________________________________________CITY_________ZIP________
EMAIL
ADDRESS_________________________________________
FATHER
MOTHER
NAME__________________________________NAME____________________________________
PHONE_________________________________PHONE___________________________________
RELIGION______________________________RELIGION________________________________
MARITAL
STATUS______________________MARITAL STATUS_________________________
STUDENT
NAME___________________________________________________________________________
Grade in Sept._____________Sex_______________
Date of Birth_____________________________Health
Problems____________________________
Has this child received? (please circle) Baptism First Confession First Communion Confirmation
Jr. PSR
(please circle your class and time)
3 year olds (by August 1st) 4 year olds
Kindergarten
Sunday 9:00 a.m. or Sunday 11:15 a.m.
Grades 1-8th
Wednesday
6:30-7:30 p.m. or Sundays 10:10-11:10 a.m. (circle best option)
Confirmation 1 and Confirmation 2: (circle best
option)
Wednesday 6:30-7:30 p.m. or Sunday 10:10-11:10 a.m. or Sunday 5:00-6:00 p.m.
Please check if student is in _____Catholic
Schools 2nd Grade or ______Confirmation
1 and 2
FEES: $30:00 per child for
ages 3-8th grade
DATE PAID _______CHECK # _______
Confirmation 1:
(Freshman) $40.00 Confirmation 2: (Sophomore) $60.00
These prices include
Confirmation 1 and Confirmation 2 retreats offered by Parish.
____If you are in need of
financial help for PSR fees please check here.
*Please use a separate form for each child *Please pay when you return the
registration forms.
*I would be willing to
volunteer.
Name_________________________________________________________
*One person my child would
like to be in class with________________________________________________
RETURN TO DEBBIE RANDELL, 2200 W. REPUBLIC RD.,