PLEASE Religious Education Program

PRINT Sts. John and Paul Church, Larchmont, NY

2007-2008

Registration Form For New Student

STUDENT INFORMATION

Student Name: ___________________________________________________________Boy/Girl _____

First Middle Last

Address:_______________________________________________________________________________

Street Town State Zip

Home Phone:_______________Date of Birth: _____________ Place: ___________________________

Home Email:__________________Grade in September ________School _________________________

[If your child has any special needs/learning issues we should be aware of, please explain on back.]

FAMILY INFORMATION

Father’s First Name: _______________Last Name___________________Living?______Religion ____

Business Phone: ____________________Cell ____________________

Mother’s First Name: _____________(Maiden) Name:_________________Living?_____Religion ____

Business Phone: ____________________Cell ____________________

If family name is different from student’s last name, please enter: _________________________________

Special Note: Mail will be sent only to the above address unless another is included here:_______________

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Please register my child for the following day: Wednesday 2:50 –4:05pm (grades 1-5) _____

Wednesday 7:20 –8:35pm (grades 6-8) _____

Sunday 10:10 –11:25am (grades K-8) _____

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REGISTRATION FEES

Registration Fee: 1 child $________ $150 per family

or 2 or more $________ $225 per family

School of Religion (S.R.A.) dues $________ $5 per family

I am enclosing the total amount. ________

-or-

I would like to be on a four-payment plan.______ My first payment of $_______ is included.

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

(OVER, please)g

I. SACRAMENTS RECEIVED:

Date Church* & Address Certificate

BAPTISM

FIRST PENANCE

FIRST COMMUNION

CONFIRMATION

*IF NOT at St. John & Paul’s Church, please ATTACH A COPY OF

YOUR CHILD’S BAPTISMAL, PENANCE, COMMUNION AND/OR CONFIRMATION CERTIFICATE now.

II. Previous Religious Education Program or Parochial School:

(Note: Please provide Permanent Record Card from previous parish.)

Name & Location of Parish School or Rel. Ed. Program? Grades Attended

III. All Other Children Living At Home:

Child’s Name Date of Birth School

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Please inform us of any special needs or learning disabilities (for the teacher’s information, otherwise confidential). Any remedial information from school would also be helpful. :

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