SRE Registration Form

2010-2011 School Year

 

Fields marked with * are required

 

Please note that a Baptismal Certificate must be on file for each student.  New students will need to provide a copy of their original Baptismal Certificate.

 

Covenant:  I have read the preceding covenant and pledge my support:*   Yes

Family Information:

Family (Last) Name:  *
Home Phone:    *
Address:  *
Address, Line 2
City:        *    State:  *   Zip: *
St. Pats Parishioner?*  Yes   No      If "yes" please enter envelope number:
Parent/Guardian #1 Name: *
Cell (or alternate) phone #1: *
Email #1:   *
Parent/Guardian #2 Name:
Cell Phone 2:    
Email 2: 

         

Marital Status:* Married    Single    Widow   Divorced   Separated

 

Emergency Contact Information:

Name:  *    Relationship to child(ren): *

Phone Number  *   Cell Phone Number*

 

"I/we authorize this person to pick up the child(ren) below."  (Proper identification will be required)*  Yes     No

 

REGISTRATION INFORMATION - CHILD #1

First Name:

Middle:

Last Name:

Age:

Birth date:

 

School District:

Grade (fall 2010) 

 

Please list any allergy or other health information that we need to be aware of 

(including conditions like ADD / ADHD or anything that will require a little extra attention):

Child #1 Sacraments already received:

Sacrament

Date Received

Parish (Type "SP" for St. Pat's)

City/State (if St. Pat's leave blank)

Catholic Baptism

Reconciliation

Eucharist

Confirmation

REGISTRATION INFORMATION - CHILD #2 (if no more children click here for next item)

First Name:

Middle:

Last Name:

Age:

Birth date:

 

School District:

Grade (fall 2010) 

 

Please list any allergy or other health information that we need to be aware of 

(including conditions like ADD / ADHD or anything that will require a little extra attention):

 

Child #2 Sacraments already received:

Sacrament

Date Received

Parish (SP for St. Pat's)

City/State (St. Pat's leave blank)

Catholic Baptism

Reconciliation

Eucharist

Confirmation

 

REGISTRATION INFORMATION - CHILD #3 (if no more children click here for next item)

First Name:

Middle:

Last Name:

Age:

Birth date:

 

School District:

Grade (fall 2010) 

 

Please list any allergy or other health information that we need to be aware of 

(including conditions like ADD / ADHD or anything that will require a little extra attention):

Child #3 Sacraments already received:

Sacrament

Date Received

Parish (SP for St. Pat's)

City/State (St. Pat's leave blank)

Catholic Baptism

Reconciliation

Eucharist

Confirmation

 

REGISTRATION INFORMATION - CHILD #4 (if no more children click here for next item)

First Name:

Middle:

Last Name:

Age:

Birth date:

 

School District:

Grade (fall 2010) 

 

Please list any allergy or other health information that we need to be aware of 

(including conditions like ADD / ADHD or anything that will require a little extra attention):

Child #4 Sacraments already received:

Sacrament

Date Received

Parish (SP for St. Pat's)

City/State (St. Pat's leave blank)

Catholic Baptism

Reconciliation

Eucharist

Confirmation

Electronic Media Release Permission*

"I hereby give my permission to St. Patrick Church and St. Patrick School of Religious Education to use sound, video and photographic images of my child(ren) named above for news releases, brochures and other SRE related productions.  Additionally, I give permission for my child(ren)'s image, work and first name to be used on the Parish web site.  I understand that no last names will be used on the web site."

Agree    Disagree

 

 

Signed (type full name): *  Date:*