St. Rose of Lima
Religious Education / Faith Formation
FAMILY REGISTRATION FORM -- 2009 – 2010

 

ARE YOU NEW TO OUR PROGRAM?   YES NO                        Click here for Page 2

 

STUDENT(S)                                                                                       PARENT/GUARDIAN’S LAST NAME
 LAST NAME IF DIFFERENT THAN STUDENT(S)

 

Mother' s Name Father's Name
                                   First                        Last                                                                                  First                        Last

MAILING ADDRESS

                                           Street Address                           Town                           State               Zip Code                                                                                                        

HOME PHONE

 

E-MAIL (Parent/guardian)

 

Are you a registered family of our Hispanic Community?    YES NO  

 

NAME AND GRADE OF CHILD/CHILDREN ATTENDING 2009 – 2010

 

                                   Name                                   REL. ED. GRADE                       SESSION/DAY

                     

                    

                    

                    

 

Please check all appropriate fees included in payment:

 

TUITION FEES:                    BY JUNE 1, 2009       AFTER 6/1/09      AFTER 8/01/09

 

   ONE CHILD                                           $130.00                          $150.00                          $170.00

  TWO OR MORE CHILDREN               $225.00                          $245.00                          $265.00

 
If Student is attending one of the following classes a SACRAMENTAL FEE of $40 is due: (Volunteers must pay sacramental fee)

 

GRADE 2                    GRADE 8                    Special Prep A, B, C II           RCIA II  

 

FOR OFFICE USE ONLY

TOTAL AMOUNT ENCLOSED __________ CHECK # _________ CASH ____

 

BALANCE DUE DATE _________________________ Initials ______________________