St Francis Student Registration Form

Office Use: Cat___

PD____ AMT_____ CHK________

Office Use: Family Last Name:_________________________________________

Student Last Name:_________________________ Student Grade___________

2010-2011 St Francis of Assisi Student Registration Form

Begin here to fill in form: Are you registered in the parish? Yes___ No___ Fees: $30-1 child [$40 if late] $35 for 2 [$45 if late] $40 for 3 [$50 if late]

Return this form with fees to the office by June 30th 2010 LATE FEES APPLICABLE AFTER JUNE 30, 2010 UNLESS YOU ARE NEWLY REGISTERED IN THE PARISH

Last name head of household:

_____________________________________________

First Name: ________________________

Title (circle) Mr. Dr. Suffix (circle) Sr. Jr. III

Last name of spouse:

_______________________________________________

First name:__________________________________

Title (circle) Ms. Mrs. Dr.

Street Address 1: _____________________________________________________

Street Address 2: _____________________________________________________

City: ____________________________________ Zip Code:_________________

Mailing address if different from street address:

______________________________________________________

City/State: ________________________ Zip Code:_____________

Father’s Home phone:______________________________ Work:_______________________________ Cell:_____________________________

Email: ____________________________________________ Send Email when possible? Yes__________ No__________

Mother’s Home phone:_______________________________ Work:___________________________Cell:_________________________

Email: ____________________________________________ Send Email when possible? Yes__________No__________

Guardian Information (if you are a guardian or foster parent):

Your Name: ______________________________________________________________________________________________

Relationship to child:______________________________________

Home phone:________________________________Work:______________________________

Cell:_______________________________ Email:_____________________________

Address:__________________________________________________ City _________________________________

State_____________________________________________Zip______________________

Adult Volunteers:

Name:___________________ can help Sun. Mornings as a catechist for grade_______ substitute for grades_______ a monitor for classrooms________

I (name]:____________________________ would like to: be an Adult Education Presenter ______ [Topic for presentation______________]

help set up/clean for Adult Ed _______

2010-2011 St Francis of Assisi Student Registration Form (page 2)

Office Use:

Last name of parent/guardian____________________________________________ Last name of Student__________________________________________

*** LIST STUDENTS FROM YOUNGEST TO OLDEST***

Student: Last Name___________________________________________________________________First Name________________________________________

Nickname: ___________________________________ Sex: M___ F___ Date of Birth________/________/____________

My child has already received the following sacraments: Baptism First Penance First Communion Confirmation

My child will receive religious education in (circle): CCD Home School Other (explain)_________________________________________________

This year my child needs to be enrolled in the program/classes for: Baptism First Penance First Communion Confirmation

CCD grade 2010-2011 school year________ Secular school grade 2010-2011 school year ________ school name__________________________

Special information (allergies, other medical, educational, etc) that we should know: