Student Registration (page 2) Student's Name
Please list local person(s) to be contacted in the event of an emergency when a parent/guardian cannot be reached:
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Phone: |
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Address: |
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Relationship to Child: |
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B |
Name: |
Phone: |
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Address: |
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Relationship to Child: |
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SACRAMENTAL RECORDS - Please attach a copy of each sacramental certificate
BAPTISM DATE COMPLETE PARISH NAME
COMPLETE PARISH ADDRESS
FIRST RECONCILIATION DATE COMPLETE PARISH NAME
COMPLETE PARISH ADDRESS
FIRST EUCHARIST DATE COMPLETE PARISH NAME
COMPLETE PARISH ADDRESS
WHERE/ WHEN DID HE/SHE ATTEND PREVIOUS RELIGIOUS INSTRUCTION? PROVIDE TRANSCRIPTS:
CHILD RESIDES WITH:
BOTH PARENTS
MOTHER
FATHER
STEPMOTHER
STEPFATHER GRANDPARENT
OTHER (PLEASE SPECIFY)
ARE THERE ANY CUSTODIAL ISSUES? Yes No
PLEASE EXPLAIN
ARE THERE ANY SPECIFIC CIRCUMSTANCES OUR OFFICE SHOULD BE AWARE OF?
I ACCEPT RESPONSIBILITY TO ADHERE TO ALL REL. ED. PROGRAM POLICIES INCLUDING THE PARKING LOT POLICIES AT CLASSTIME. I UNDERSTAND IT IS MY RESPONSIBILITY TO INFORM ANY OTHER PERSON RESPONSIBLE FOR MY CHILD’S TRANSPORTATION OF THE REL. ED. PROGRAM POLICIES INCLUDING THE PARKING LOT POLICIES.
PARENT/GUARDIAN SIGNATURE ________________________________________________ DATE
I give permission for my child to be photographed for group photo displays in the school &/or church/chapel. Yes No
PARENT/GUARDIAN SIGNATURE_________________________________________________ DATE
REL. ED. GRADE SESSION/DAY (chose one)