Religious Education Program:  Registration Form

 

E-mail stmary@the-spa.com

FAMILY'S LAST NAME:

PARISH SUPPORT ENVELOPE NUMBER:
FATHER'S NAME:

MOTHER'S NAME:
STEP-PARENT NAME:

ADDRESS:

CITY/TOWN: STATE: ZIP:
TELEPHONE:
EMERGENCY NAME & PHONE:
I request that the following children be enrolled in the Parish Religious Education Program. The Policy Statement has been read and our family agrees to cooperate with its conditions. I understand that a parent or other authorized adult must enter the building at dismissal time to meet students enrolled in Levels 1-8. Responsibility will be assumed for lost textbooks.
Signature Of Parent/Guardian:

 

STUDENT INFORMATION:

1. First: MiddleLast:
Name of School: School Grade 09/2005

St. Mary's Level 09/2004
2. First: MiddleLast:
Name of School: School Grade 09/2005

St. Mary's Level 09/2004

3. First: MiddleLast:
Name of School: School Grade 09/2005

St. Mary's Level 09/2004

4. First: MiddleLast:
Name of School: School Grade 09/2005

St. Mary's Level 09/2004

 

SPECIAL INFORMATION CONCERNING STUDENT
Please advise of any special medical/emotional conditions or circumstances that Catechist should be sensitive to so that student will be comfortable in the classroom.

INFORMATION FOR NEW STUDENTS

(Previously enrolled students have information on records.)
Please submit records of children who celebrated sacraments at churches other than St. Mary's, Springfield. They will be copied and returned.

1. NAME:BIRTH DATE:

C H U R C H & Y E A R OF:
BAPTISM:

RECONCILIATION:

FIRST EUCHARIST:
2.NAME:BIRTH DATE:

C H U R C H & Y E A R OF:
BAPTISM:

RECONCILIATION:

FIRST EUCHARIST:

3. NAME:BIRTH DATE:

C H U R C H & Y E A R OF:
BAPTISM:

RECONCILIATION:

FIRST EUCHARIST:
4. NAME:BIRTH DATE:

C H U R C H & Y E A R OF:
BAPTISM:

RECONCILIATION:

FIRST EUCHARIST:

Registration Fees

Before June 30th
$ ______ 15.00 FOR 1 STUDENT
$ ______ 28.00 FOR 2 STUDENTS
$ ______ 35.00 FOR 3 OR MORE STUDENTS

After June 30th
$ ______ 25.00 FOR 1 STUDENT
$ ______ 48.00 FOR 2 STUDENTS
$ ______ 65.00 FOR 3 OR MORE STUDENTS

$ _0.00_ NO FEE FOR PAROCHIAL SCHOOL STUDENTS

$ _0.00_ NO FEE FOR CHILDREN OF STAFF
$ _0.00_ PERFECT ATTENDANCE TUITION CERTIFICATES

$ ______ 35.00 PER STUDENT FOR NON-PARISHIONERS

$ ______ PREVIOUS FEES NOT PAID FOR YEARS: ________

$ ______ TOTAL AMOUNT OF FEE

FOR OFFICE NOTATION ONLY
PROGRAM REGISTRATION NUMBER: _________________
DATE REGISTRATION RECEIVED: ____/____/________
DATE FEE PAID: ____/____/________

Copyright @  2004 St Mary's Parish Community.
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Last modified December, 2005