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2011- 2012 PSR Family Registration
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Last Name
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Has any of your contact information changed since last year?
Yes
No
Not applicable
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If the answer is "Yes" please indicate what has changed:
Address
Email Address
Phone number
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If an email address or phone number has changed, please indicate who it belongs to:
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Family email address
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Marital Status of Parents
Married
Separated
Divorced
Deceased
Remarried
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Child(ren) live(s) with:
Both Parents
Mother
Father
Guardian
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Father's Name, Home Phone, Work Phone, Cell Phone
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Father's Email address
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Father's Mailing Address
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Mother's Name, Home Phone, Work Phone, Cell Phone
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Mother's Email address
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Mother's Mailing address (if different)
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Guardian's Name, Home Phone, Work Phone, Cell Phone
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Guardian's Email Address
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Guardian's Mailing Address
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CHILDREN BEING REGISTERED (Grades K4-8)
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(***K4s also need to have a "New Student Permanent Record Form" filled out.***)
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CHILD 1 FULL NAME
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Gender
Male
Female
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Grade
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Age as of Sept. 1
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Date of Birth (m/d/y)
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School
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Sacraments Received
Baptism
Reconciliation
Eucharist
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CHILD 2 FULL NAME
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Gender
Male
Female
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Grade
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Age as of Sept. 1
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Date of Birth (m/d/y)
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School
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Sacraments Received
Baptism
Reconciliation
Eucharist
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CHILD 3 FULL NAME
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Gender
Male
Female
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Grade
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Age as of Sept. 1
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Date of Birth (m/d/y)
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School
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Sacraments Received
Baptism
Reconciliation
Eucharist
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CHILD 4 FULL NAME
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Gender
Male
Female
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Grade
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Age as of Sept. 1
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Date of Birth (m/d/y)
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School
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Sacraments Received
Baptism
Reconciliation
Eucharist
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CHILD 5 FULL NAME
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Gender
Male
Female
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Grade
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Age as of Sept. 1
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Date of Birth (m/d/y)
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School
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Sacraments Received
Baptism
Reconciliation
Eucharist
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Do any of these children have special needs that should be brought to our attention? (i.e., allergies, learning and/or behavioral concerns, physical needs,special medication)
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Additional Comments
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REGISTRATION FEE AMOUNT
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Payment method
Check
Cash
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PLEASE NOTE: If you have not gotten an email confirmation from us by Aug. 15, you need to call the PSR office to verify you are registered in PSR. Thank you!
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VOLUNTEER OPPORTUNITIES
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Would you be willing to substitute teach OR help direct traffic before/after PSR?
Yes
No
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If willing to substitute teach, please note the grade(s) in which you're interested.
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