Saint Theresa Parish Religious Education Program New Student Registration Levels 1-8

Email Communications
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We utilize an automated phone and email messaging system for class cancellations, schedule changes, and important reminders. Please list here your email and the numbers(s) you would like us to call with messages regardings cancellations and reminders below.
Phone -- ext
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In addition, we need your phone number for cancellations and reminders.
Registering For:
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Name
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Family Name
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Home Phone --
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Address
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Mother's Name
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Mother's Maiden Name
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Mother's Religious Affiliation
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Father's Name
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Father's Religious Affiliation
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Name
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Please provide a contact in the event we cannot reach you in an emergency
Phone -- ext
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Emergency contact phone number
Physician's Name
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I authorize the staff of Saint Theresa to seek emergency medical care for my child as deemed appropriate
Physician's Phone Number --
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Hospital Preference
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Our program is volunteer based. Please consider helpfin in one of the following areas:
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Comments/Concerns:
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Signature
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In registering my child for Saint Theresa Religous Formation, I acknowledge that I have a responsibility, as the primary faith educator of my child, to support the teaching of religion and to assist my student's education by our family practice of prayer and good works, observing the Law of God and attending Mass each Sunday and Holy Day. I agree to abide by the policies in the parent handbook.
Religious Education Registration Fees for 2018-2019: One Child: $ 90.00 Two Children: $100.00 Three or More Children: $130.00 AFTER 8/1/18 Includes LATE FEE One Child: $100.00 Two Children: $125.00 Three or More Chidlren: $150.00
Payment
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Check #
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Add check number if paid by check. Payment by check or credit card can be made online by going to "www.sainttheresaparish.org" home page and clicking on icon "Online Donation System". Choose "Rel Education" and enter the amount due.
Student Information Child #1
Name
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Age
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2018-2019 Grade
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School Attending
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Date of Birth //
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Church Baptized
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Date Baptized //
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If child received any prior formal religious education, please indicate where.
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Sacraments Received
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Child Health Status
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Student Information Child #2
Name
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Age
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2018-2019 Grade
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School Attending
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Date of Birth //
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Church Baptized
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Date Baptized //
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If child received any prior formal religious education, please indicate where.
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Sacraments Received
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Child Health Status
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Student Information Child #3
Name
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Age
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2018-2019 Grade
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School Attending
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Date of Birth //
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Church Baptized
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Date Baptized //
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If child received any prior formal religious education, please indicate where.
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Sacraments Received
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Child Health Status
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