Mission San Luis Rey Parish

NEW STUDENT REGISTRATION FORM

ENGLISH FAITH FORMATION 2014-2015 Semester




Class language preferred (Please circle one): ENGLISH SPANISH




TODAYS DATE: Envelope/PDS # _________________________


FAMILY NAME: __________________________________________________________________________


STREET ADDRESS: _______________________________________________________________________

CITY: ZIP CODE: _____________________________

HOME PHONE #: CELL PHONE # _____________________________


E-MAIL ADDRESS: ________________________________________________________________

Registration forms are also available on-line at www.sanluisreyparish.org click on Faith Formation.
Parents must request sacraments for their children in writing, attend specific sacramental preparation classes and
turn in the childs Baptism Certificate, child must be in the 3
rd
grade or higher, see parent handbook for details.


====================PARENT / GUARDIAN INFORMATION====================


Names listed below must be LEGAL or COURT APPOINTED GUARDIANS.


(circle one) FATHER LEGAL GUARDIAN (circle one) MOTHER LEGAL GUARDIAN



FATHERS NAME: ___________________________ MOTHERS NAME: ____________________________


Receipt # _____________________________ Total Due: _____________________________

Amount Enclosed: _______________ Balance: ______________ Ck # __________
Tuition: One Child $60; Two $120; Three $180; Pre-Confirmation $60; Confirmation $175
Registrations will not be processed until payment is received.
Program Code (office use) 1F English 2F Spanish 3F Youth 4F RCIA


Rev 5/23/14 (Front side Pg. 1)




FIRST CHILD


NAME OF STUDENT ____________________________________________________________________
(Last Name) (First)

FAMILY LAST NAME (If different from the student): ______________________________________

Grade your child will be in school year (2014-2015): SEX: ____________

Birth Date: / / Birth Place: __________________________________________

Has your child attended Faith Formation Classes before? (Please circle one) YES NO

If yes, where? ________________________________________________________________________

CIRCLE PREVIOUS RELIGIOUS EDUCATION: NONE Grades 1 2 3 4 5 6 7 8

My child was Baptized: YES NO (Church Name) _______________________________

PLEASE CIRCLE (BELOW) THE SACRAMENTS YOUR CHILD HAS RECEIVED:

Baptism First Reconciliation (Confession) First Eucharist (Communion) Confirmation

PLEASE CIRCLE (BELOW) THE SACRAMENT/S YOU ARE REQUESTING:

Baptism First Reconciliation (Confession) First Eucharist (Communion) Confirmation

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * *

AUTHORIZATION - EMERGENCY & HEALTH INFORMATION:

During class time I may be reached by calling #: ____________________________. If I cannot be
reached, the following person is authorized to make medical decisions on my behalf:

Name: ______________________________________ Phone # ______________________

Relationship to my child: _______________________________________________________

Allergies or medical condition (Diabetes etc.) _______________________________________________

My child is on the following medications: __________________________________________________

My child has Special Needs (Autism, ADD, ADHD, Downs, a Learning disability) YES NO

Please describe: _______________________________________________________________

I give consent for my child to receive first aid and/or 9-1-1 medical treatment. YES NO


Signature below authorizes my child to participate in the Faith Formation Program of this Parish.


Parent Signature: _________________________________________ Date: _______________
(Signature must be of a parent or a Legal or Court Appointed Guardian)


PROGRAM COORDINATOR USE ONLY: FIRST CHILD

Grade/Room # __ Coordinator: _____________ Date: _____________

(Back Side Pg 2)



SECOND CHILD


NAME OF STUDENT ____________________________________________________________________
(Last Name) (First)

FAMILY LAST NAME (If different from the student): ______________________________________

Grade your child will be in school year (2014-2015): SEX: ____________

Birth Date: / / Birth Place: __________________________________________

ETHNIC BACKGROUND (Diocese Request): __________________________________________________

Has your child attended Faith Formation Classes before? (Please circle one) YES NO

If yes, where? ________________________________________________________________________

CIRCLE PREVIOUS RELIGIOUS EDUCATION: NONE Grades 1 2 3 4 5 6 7 8

My child was Baptized: YES NO (Church Name) _______________________________

PLEASE CIRCLE (BELOW) THE SACRAMENTS YOUR CHILD HAS RECEIVED:

Baptism First Reconciliation (Confession) First Eucharist (Communion) Confirmation

PLEASE CIRCLE (BELOW) THE SACRAMENT/S YOU ARE REQUESTING THIS YEAR:

Baptism First Reconciliation (Confession) First Eucharist (Communion) Confirmation

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * *

AUTHORIZATION - EMERGENCY & HEALTH INFORMATION:

During class time I may be reached by calling #: ____________________________. If I cannot be
reached, the following person is authorized to make medical decisions on my behalf:

Name: ______________________________________ Phone # ______________________

Relationship to my child: _______________________________________________________

Allergies or medical condition (Diabetes etc.) _______________________________________________

My child is on the following medications: __________________________________________________

My child has Special Needs (Autism, ADD, ADHD, Downs, a Learning disability) YES NO

Please describe: _______________________________________________________________

I give consent for my child to receive first aid and/or 9-1-1 medical treatment. YES NO


Signature below authorizes my child to participate in the Faith Formation Program of this Parish.


Parent Signature: _________________________________________ Date: _______________
(Signature must be of a parent or a Legal or Court Appointed Guardian)

PROGRAM COORDINATOR USE ONLY: SECOND CHILD

Grade/Room # __ Coordinator: ______________ Date: _____________

(Front Side Pg 3)



THIRD CHILD


NAME OF STUDENT ____________________________________________________________________
(Last Name) (First)

FAMILY LAST NAME (If different from the student): ______________________________________

Grade your child will be in school year (2014-2015): SEX: ____________

Birth Date: / / Birth Place: __________________________________________

ETHNIC BACKGROUND (Diocese Request): __________________________________________________

Has your child attended Faith Formation Classes before? (Please circle one) YES NO

If yes, where? ________________________________________________________________________

CIRCLE PREVIOUS RELIGIOUS EDUCATION: NONE Grades 1 2 3 4 5 6 7 8

My child was Baptized: YES NO (Church Name) _______________________________

PLEASE CIRCLE (BELOW) THE SACRAMENTS YOUR CHILD HAS RECEIVED:

Baptism First Reconciliation (Confession) First Eucharist (Communion) Confirmation

PLEASE CIRCLE (BELOW) THE SACRAMENT/S YOU ARE REQUESTING THIS YEAR:

Baptism First Reconciliation (Confession) First Eucharist (Communion) Confirmation

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * *

AUTHORIZATION - EMERGENCY & HEALTH INFORMATION:

During class time I may be reached by calling #: ____________________________. If I cannot be
reached, the following person is authorized to make medical decisions on my behalf:

Name: ______________________________________ Phone # ______________________

Relationship to my child: _______________________________________________________

Allergies or medical condition (Diabetes etc.) _______________________________________________

My child is on the following medications: __________________________________________________

My child has Special Needs (Autism, ADD, ADHD, Downs, a Learning disability) YES NO

Please describe: _______________________________________________________________

I give consent for my child to receive first aid and/or 9-1-1 medical treatment. YES NO


Signature below authorizes my child to participate in the Faith Formation Program of this Parish.


Parent Signature: _________________________________________ Date: _______________
(Signature must be of a parent or a Legal or Court Appointed Guardian)

PROGRAM COORDINATOR USE ONLY: THIRD CHILD

Grade/Room # __ Coordinator: Date: _

(Back Side Pg 4)