FAMILY RE-REGISTRATION FORM 2006/07

Religious Education Program

Sts. John and Paul Church, Larchmont, NY 10538

834-4597 phone 833-5081 fax

FAMILY INFORMATION [PLEASE PRINT]

Last name of child: ____________________________________________

If parents’ last names are different, please indicate: ______________(mother’s)_______________(father’s)

Phone number (home)___________________(cell)___________________Email_____________________

Address (only if different this year)_________________________________________________________

STUDENT INFORMATION

Please list below all children who are re-registering. (If you have a child registering for the first time, please fill out the information for that child on the back of this form.)

First Name Boy/Girl Day (Wed. or Sun.) Grade in Sept. School

________________ ________ __________ _________ _____________________

(If any of your children have special needs or learning issues that we should be aware of, please explain on the back of this form. This is confidential information for the catechist.)

REGISTRATION FEES

Registration Fee: $________ $150 per family (1 child)

$225 per family (2 or more children)

Parent Association (SRA) Dues: $________ $ 5 per family

TOTAL: $________ (checks payable to: Sts. John and Paul)

I am enclosing the total amount. ________ I would like to be on a four-payment plan._________

My first payment of $_______ is included.

_______________________________________________________________________________________

Office use only: Amount Collected: ____________ Check #: ___________ Cash: ___________

OVERg

NEW STUDENT REGISTRATION PLEASE PRINT

(If there is someone new in your family who is joining our program, please enter her/him here.)

Name: ________________________________________________________________M/F

First Middle Last (If different from siblings)

Grade in September ‘06: _ School: _____________________________________

Date of birth: ________________ Place of birth: ___________________________________________

Date of Baptism*: _____________ Church*: ______________________________________________

* If new student was NOT baptized at St. John & Paul’s Church,

PLEASE attach a copy of the Baptismal Certificate with this form.

(If Sts. John & Paul was the church of baptism, a certificate is not necessary; we will simply verify the date at our rectory if you could provide year and/or month!)

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Continued from the front:

If your child has any special needs or learning issues that we should be aware of, please explain:

(Please feel free to describe any learning modifications that the school provides. This will help us

to help your child.)

_______________________________________________________________________________________