Mission San Luis Rey Parish "New Student" Registration Form ENGLISH FAITH FORMATION 2012-2013 Semester
Uploaded by
sanluisreyparishMission San Luis Rey Parish "New Student" Registration Form ENGLISH FAITH FORMATION 2012-2013 Semester
Uploaded by
sanluisreyparishMission San Luis Rey Parish
NEW STUDENT REGISTRATION FORM
ENGLISH FAITH FORMATION 2012-2013 Semester
Class language preferred (Please circle one):
ENGLISH
SPANISH
Letters sent home preferred: (Language preferred):
ENGLISH
SPANISH
TODAYS DATE:
Envelope/PDS # _________________________
FAMILY NAME: __________________________________________________________________________
STREET ADDRESS: _______________________________________________________________________
CITY:
ZIP CODE: _____________________________
HOME PHONE #:
CELL PHONE # _____________________________
E-MAIL ADDRESS: ________________________________________________________________
I AM AVAILABLE TO HELP OUT IN THE CLASSROOM.
(Please circle one)
I AM INTERESTED IN BECOMING A RELIGIOUS EDUCATION TEACHER.
YES
NO
Undecided
YES
NO
Undecided
====================PARENT / GUARDIAN INFORMATION====================
Names listed below must be LEGAL or COURT APPOINTED GUARDIANS.
(circle one)
FATHER
(circle one)
LEGAL GUARDIAN
MOTHER
LEGAL GUARDIAN
FATHERS NAME: ___________________________
MOTHERS NAME: ____________________________
Receipt # _____________________________
Total Due: _____________________________
Amount Enclosed: _______________
Balance: ______________
Tuition: One Child $70; Two $110; Three $150; Four $190.
Program Code (office use)
1F English
2F Spanish
Ck # __________
Pre-School $40.
3F Youth
4F RCIA
(Front side Pg 1)
FIRST CHILD
NAME OF STUDENT ____________________________________________________________________
(Last Name)
(First)
FAMILY LAST NAME (If different from the student): ______________________________________
Grade your child will be in school year (2012-2013):
Birth Date:
SEX: ____________
Birth Place: __________________________________________
ETHNIC BACKGROUND (Diocese Request): __________________________________________________
(Please circle one)
Has your child attended Faith Formation Classes before?
YES
NO
If yes, where? ________________________________________________________________________
CIRCLE PREVIOUS RELIGIOUS EDUCATION:
My child was Baptized:
YES
NO
NONE
Grades 1
(Church Name) _______________________________
PLEASE CIRCLE (BELOW) THE SACRAMENTS YOUR CHILD HAS RECEIVED:
Baptism
First Reconciliation (Confession)
First Eucharist (Communion)
Confirmation
PLEASE CIRCLE (BELOW) THE SACRAMENT/S YOU ARE REQUESTING:
Baptism
First Reconciliation (Confession)
First Eucharist (Communion)
Confirmation
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * *
AUTHORIZATION - EMERGENCY & HEALTH INFORMATION:
During class time I may be reached by calling #: ____________________________. If I cannot be
reached, the following person is authorized to make medical decisions on my behalf:
Name: ______________________________________
Phone # ______________________
Relationship to my child: _______________________________________________________
Allergies or medical condition (Diabetes etc.) _______________________________________________
My child is on the following medications: __________________________________________________
My child has a learning disability AND/OR Special Needs (Autism, ADD, ADHD, etc.)
YES
NO
Please describe: _______________________________________________________________
I give consent for my child to receive first aid and/or 9-1-1 medical treatment.
YES
NO
Signature below authorizes my child to participate in the Faith Formation Program of this Parish.
Parent Signature: _________________________________________ Date: _______________
(Signature must be of a parent or a Legal or Court Appointed Guardian)
PROGRAM COORDINATOR USE ONLY: FIRST CHILD
Grade/Room #
__
Coordinator: _____________ Date: _____________
(Back Side Pg 2)
SECOND CHILD
NAME OF STUDENT ____________________________________________________________________
(Last Name)
(First)
FAMILY LAST NAME (If different from the student): ______________________________________
Grade your child will be in school year (2012-2013):
Birth Date:
SEX: ____________
Birth Place: __________________________________________
ETHNIC BACKGROUND (Diocese Request): __________________________________________________
(Please circle one)
Has your child attended Faith Formation Classes before?
YES
NO
If yes, where? ________________________________________________________________________
CIRCLE PREVIOUS RELIGIOUS EDUCATION:
My child was Baptized:
YES
NO
NONE
Grades 1
(Church Name) _______________________________
PLEASE CIRCLE (BELOW) THE SACRAMENTS YOUR CHILD HAS RECEIVED:
Baptism
First Reconciliation (Confession)
First Eucharist (Communion)
Confirmation
PLEASE CIRCLE (BELOW) THE SACRAMENT/S YOU ARE REQUESTING THIS YEAR:
Baptism
First Reconciliation (Confession)
First Eucharist (Communion)
Confirmation
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * *
AUTHORIZATION - EMERGENCY & HEALTH INFORMATION:
During class time I may be reached by calling #: ____________________________. If I cannot be
reached, the following person is authorized to make medical decisions on my behalf:
Name: ______________________________________
Phone # ______________________
Relationship to my child: _______________________________________________________
Allergies or medical condition (Diabetes etc.) _______________________________________________
My child is on the following medications: __________________________________________________
My child has a learning disability AND/OR Special Needs (Autism, ADD, ADHD, etc.)
YES
NO
Please describe: _______________________________________________________________
I give consent for my child to receive first aid and/or 9-1-1 medical treatment.
YES
NO
Signature below authorizes my child to participate in the Faith Formation Program of this Parish.
Parent Signature: _________________________________________ Date: _______________
(Signature must be of a parent or a Legal or Court Appointed Guardian)
PROGRAM COORDINATOR USE ONLY: SECOND CHILD
Grade/Room #
__
Coordinator: ______________ Date: _____________
(Front Side Pg 3)
THIRD CHILD
NAME OF STUDENT ____________________________________________________________________
(Last Name)
(First)
FAMILY LAST NAME (If different from the student): ______________________________________
Grade your child will be in school year (2012-2013):
Birth Date:
SEX: ____________
Birth Place: __________________________________________
ETHNIC BACKGROUND (Diocese Request): __________________________________________________
(Please circle one)
Has your child attended Faith Formation Classes before?
YES
NO
If yes, where? ________________________________________________________________________
CIRCLE PREVIOUS RELIGIOUS EDUCATION:
My child was Baptized:
YES
NO
NONE
Grades 1
(Church Name) _______________________________
PLEASE CIRCLE (BELOW) THE SACRAMENTS YOUR CHILD HAS RECEIVED:
Baptism
First Reconciliation (Confession)
First Eucharist (Communion)
Confirmation
PLEASE CIRCLE (BELOW) THE SACRAMENT/S YOU ARE REQUESTING THIS YEAR:
Baptism
First Reconciliation (Confession)
First Eucharist (Communion)
Confirmation
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * *
AUTHORIZATION - EMERGENCY & HEALTH INFORMATION:
During class time I may be reached by calling #: ____________________________. If I cannot be
reached, the following person is authorized to make medical decisions on my behalf:
Name: ______________________________________
Phone # ______________________
Relationship to my child: _______________________________________________________
Allergies or medical condition (Diabetes etc.) _______________________________________________
My child is on the following medications: __________________________________________________
My child has a learning disability AND/OR Special Needs (Autism, ADD, ADHD, etc.)
YES
NO
Please describe: _______________________________________________________________
I give consent for my child to receive first aid and/or 9-1-1 medical treatment.
YES
NO
Signature below authorizes my child to participate in the Faith Formation Program of this Parish.
Parent Signature: _________________________________________ Date: _______________
(Signature must be of a parent or a Legal or Court Appointed Guardian)
PROGRAM COORDINATOR USE ONLY: THIRD CHILD
Grade/Room #
__
Coordinator: ______________ Date: _____________
(Back Side Pg 4)
