Register for PSR

Are you a registered parishioner of Ss. Robert & William, St. John of the Cross or Neither REQUIRED Ss. Robert & William St. John of the Cross Neither Please fill out this field.

FAMILY INFORMATION:

Father's Name REQUIRED Please fill out this field. Please enter valid data.
Father's Religion REQUIRED Please fill out this field. Please enter valid data.
Mother's Name REQUIRED Please fill out this field. Please enter valid data.
Mother's Religion REQUIRED Please fill out this field. Please enter valid data.
Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Primary Contact Phone Number REQUIRED Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Child/Children live with: REQUIRED Mom & Dad Mom Dad Grandparents Other Please fill out this field.

How many children are you registering? REQUIRED Please fill out this field.
CHILD 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Baptism Date
  Please supply a copy of baptism certificate if from another parish
  Please enter a date.
- Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
- First Communion Date
  If applicable
  Please enter a date.
- Church of First Communion
  If applicable
  Please enter valid data.
- Has this child received the Sacrament of Reconciliation? REQUIRED Please fill out this field.
- Day School of Attendance REQUIRED Please fill out this field. Please enter valid data.
- Current Grade Level REQUIRED Please fill out this field.
- Are there any educational or psychological concerns, family situations, or custody arrangements that we should be aware of in order to best minister to your child?
- Previous Religious Education: REQUIRED Please fill out this field.
- Last parish of religious education:
  If applicable
  Please enter valid data.
- Medical, physical conditions, special needs, or food allergies?
CHILD 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Baptism Date
  Please supply a copy of baptism certificate if from another parish
  Please enter a date.
- Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
- First Communion Date
  If applicable
  Please enter a date.
- Church of First Communion
  If applicable
  Please enter valid data.
- Has this child received the Sacrament of Reconciliation? REQUIRED Please fill out this field.
- Day School of Attendance REQUIRED Please fill out this field. Please enter valid data.
- Current Grade Level REQUIRED Please fill out this field.
- Are there any educational or psychological concerns, family situations, or custody arrangements that we should be aware of in order to best minister to your child?
- Previous Religious Education: REQUIRED Please fill out this field.
- Last parish of religious education:
  If applicable
  Please enter valid data.
- Medical, physical conditions, special needs, or food allergies?
CHILD 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Baptism Date
  Please supply a copy of baptism certificate if from another parish
  Please enter a date.
- Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
- First Communion Date
  If applicable
  Please enter a date.
- Church of First Communion
  If applicable
  Please enter valid data.
- Has this child received the Sacrament of Reconciliation? REQUIRED Please fill out this field.
- Day School of Attendance REQUIRED Please fill out this field. Please enter valid data.
- Current Grade Level REQUIRED Please fill out this field.
- Are there any educational or psychological concerns, family situations, or custody arrangements that we should be aware of in order to best minister to your child?
- Previous Religious Education: REQUIRED Please fill out this field.
- Last parish of religious education:
  If applicable
  Please enter valid data.
- Medical, physical conditions, special needs, or food allergies?
CHILD 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Baptism Date
  Please supply a copy of baptism certificate if from another parish
  Please enter a date.
- Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
- First Communion Date
  If applicable
  Please enter a date.
- Church of First Communion
  If applicable
  Please enter valid data.
- Has this child received the Sacrament of Reconciliation? REQUIRED Please fill out this field.
- Day School of Attendance REQUIRED Please fill out this field. Please enter valid data.
- Current Grade Level REQUIRED Please fill out this field.
- Are there any educational or psychological concerns, family situations, or custody arrangements that we should be aware of in order to best minister to your child?
- Previous Religious Education: REQUIRED Please fill out this field.
- Last parish of religious education:
  If applicable
  Please enter valid data.
- Medical, physical conditions, special needs, or food allergies?
CHILD 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Baptism Date
  Please supply a copy of baptism certificate if from another parish
  Please enter a date.
- Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
- First Communion Date
  If applicable
  Please enter a date.
- Church of First Communion
  If applicable
  Please enter valid data.
- Has this child received the Sacrament of Reconciliation? REQUIRED Please fill out this field.
- Day School of Attendance REQUIRED Please fill out this field. Please enter valid data.
- Current Grade Level REQUIRED Please fill out this field.
- Are there any educational or psychological concerns, family situations, or custody arrangements that we should be aware of in order to best minister to your child?
- Previous Religious Education: REQUIRED Please fill out this field.
- Last parish of religious education:
  If applicable
  Please enter valid data.
- Medical, physical conditions, special needs, or food allergies?
CHILD 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Baptism Date
  Please supply a copy of baptism certificate if from another parish
  Please enter a date.
- Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
- First Communion Date
  If applicable
  Please enter a date.
- Church of First Communion
  If applicable
  Please enter valid data.
- Has this child received the Sacrament of Reconciliation? REQUIRED Please fill out this field.
- Day School of Attendance REQUIRED Please fill out this field. Please enter valid data.
- Current Grade Level REQUIRED Please fill out this field.
- Are there any educational or psychological concerns, family situations, or custody arrangements that we should be aware of in order to best minister to your child?
- Previous Religious Education: REQUIRED Please fill out this field.
- Last parish of religious education:
  If applicable
  Please enter valid data.
- Medical, physical conditions, special needs, or food allergies?

PHOTO CONSENT

I (we) the parent(s) and/or guardians of my (our) minor (child)ren, do hereby consent and authorize the release, publication, dissemination, distribution, use, and/or reproduction of any and all photographs taken of my(our) daughter(s)/son(s) during his/her enrollment at the Ss. Robert & William / Saint John of the Cross Parish School of Religion by an employee, agent, or representative of the Ss. Robert & William / Saint John of the Cross Parish School of Religion, or an independent contractor.

This Release and authorization acknowledge that all photographic proofs, photographic negatives, positives, and prints shall constitute the property of the Ss. Robert & William / Saint John of the Cross Parish School of Religion and may be used by Saint John of the Cross Parish for any purpose* determined at its discretion without further notice or any compensation to me or to my daughter(s)/son(s).

*Primary uses of these photos would be on the parish websites, srweuclid.cc or sjceuclid.com, and/or its social media outlets. Please note that your child(ren) will never be identified by name.
Photo Release Consent REQUIRED I Agree to the Photo Release Terms I Do Not Agree to the Photo Release Terms Please fill out this field.
Name of parent/guardian granting consent REQUIRED Please fill out this field. Please enter valid data.

EMERGENCY MEDICAL CONTACT

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Relationship to family REQUIRED Please fill out this field. Please enter valid data.
Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
Secondary Number Please enter a phone number.

PROGRAM INFORMATION

We are selecting to participate in PSR by way of… REQUIRED Traditional classroom Homeschool Online platform Please fill out this field.

ADDITIONAL INFORMATION

For each child that will be participating in PSR for the first time through our program, please submit a copy of his/her baptismal certificate if the sacrament was NOT received at Ss. Robert & William or Saint John of the Cross.

Tuition Information - How many children are you registering for PSR? REQUIRED

Please select a number. You have the option to pay later.

Please fill out this field.

Register for PSR

Click Here PDF for the most up-to-date information regarding PSR.