2017-2018 Religious Education Grades 1 8 - Please Print Clearly and Provide All Information
2017-2018 Religious Education Grades 1 – 8 - Please print clearly and provide all information requested. If you have more than 3 children to be registered please copy or request a separate sheet for additional children. – Thank You
Child’s InformationChild’s Legal Name / Gender
M or F / Birth date / Public School and Grade they will be attending in September
Class Selection – Please refer to the back page of the cover letter for class options
Grade / Day
Circle One / Time / If your child has allergies or other medical conditions we should be aware of please complete the attached form. If they do not have any medical issues please initial below
□ My child does not have any medical issues ______
Sunday
Tuesday
Wednesday / □ Sunday 8:45 – 10:15
□ 4:30 – 6:00 □ 6:30 – 8:00
Sacramental History – You only need to complete this section IF the child is new to our program (i.e. 1st grade)
Baptismal Date / Name of Church / City & State
First Reconciliation Date / Name of Church – if different than Baptismal Church / City & State
First Eucharist Date / Name of Church – if different than Baptismal Church / City & State
Child’s Information
Child’s Legal Name / Gender
M or F / Birth date / Public School and Grade they will be attending in September
Class Selection – Please refer to the back page of the cover letter for class options
Grade / Day
Circle One / Time / If your child has allergies or other medical conditions we should be aware of please complete the attached form. If they do not have any medical issues please initial below
□ My child does not have any medical issues ______
Sunday
Tuesday
Wednesday / □ Sunday 8:45 – 10:15
□ 4:30 – 6:00 □ 6:30 – 8:00
Sacramental History – You only need to complete this section IF the child is new to our program (i.e. 1st grade)
Baptismal Date / Name of Church / City & State
First Reconciliation Date / Name of Church – if different than Baptismal Church / City & State
First Eucharist Date / Name of Church – if different than Baptismal Church / City & State
Child’s Information
Child’s Legal Name / Gender
M or F / Birth date / Public School and Grade they will be attending in September
Class Selection – Please refer to the back page of the cover letter for class options
Grade / Day
Circle One / Time / If your child has allergies or other medical conditions we should be aware of please complete the attached form. If they do not have any medical issues please initial below
□My child does not have any medical issues ______
Sunday
Tuesday
Wednesday / □ Sunday 8:45 – 10:15
□ 4:30 – 6:00 □ 6:30 – 8:00
Sacramental History – You only need to complete this section IF the child is new to our program (i.e. 1st grade)
Baptismal Date / Church Name / City & State
First Reconciliation Date / Church Name (if different then Baptismal Church) / City & State
First Eucharist Date / Church Name (if different then Baptismal Church) / City & State
Please review the instructions below before completing the information requested. Religious Education Program class placement is on a first come first serve base. Before sending in please complete both sides of this form.
1. A copy of your child’s Baptism certificate (or exact date if baptized at St. Therese). If you need to request a copy from the Baptismal Church you can still send in this form for processing.
2. Tuition payment: The first year’s tuition for new families is $230 per year for one child, $300 for 2; $350 for 3 or more children. Beginning the second year, our tuition fee is based on active/non-active parishioner status.
Class Options
Grades 1 - 8 Sundays 8:45 – 10:15 am A & B schedule
Grades 1 – 8 Tuesday 4:30 – 6:00 pm A & B schedule
Grades 5 – 8 Tuesday 6:30 – 8:00 pm B schedule only
Grades 1 – 6 Wednesday 4:30 – 6:00 pm A schedule only
Our home schooling option is available to students in grades 3 – 8. For addition information call the Religious Education office to discuss this preference.
Name (please give the Family name (Last Name) you used to register in the parish)
Mailing Address (include zip code) / Home Phone number (include area code)
Family Email Address (this is the address we will use for program closings etc.) / Mother’s Maiden Name
Mother’s Name (include last name if different) / Religion / Day time Phone Number (include area code & indicate work or cell)
Father’s Name (include last name if different) / Religion / Day time Phone Number (include area code & indicate work or cell)
TUITION PAYMENT is expected at the time of registration. Families experiencing financial difficulties are encouraged to contact the Director of Religious Education to request alternate arrangements. No family will ever be turned away because of financial hardship.
As a new family registering into the Religious Education program your status is New for the first year. Your fee is $230 for one child $300 for two children or $350 for 3 or more children. After the second year we will check the status (determined by the Rectory).
Basic Tuition: $ ______
Sacrament Fee: + $35 per child (Grade 2 child only) $ ______
Optional additional donation for program resources: $ ______
The optional donation helps defray the cost of special purchases (i.e. books, dvd’s) activities or events for the program
Total enclosed: $ ______
PHOTO RELEASE:
I give my permission for my children's photo to be taken during class times and other program events. I understand that these photos may be used in a display inside church property and/or posted on the parish website, and/or may be submitted to local newspapers. I may withdraw my consent at any time by submitting such request in writing to the Director of Religious Education. ______Permission Denied if initialed
I have reviewed and agree to abide by polices contained in the Family Handbook which can be viewed online at www.StThereseRoxbury.org (under Religious Education, click Grades 1-8). Printed copies available upon request.
Parent/Guardian Signature: ______Date: ______