2012-2013 RELIGIOUS EDUCATION REGISTRATION FORM
FAMILY LAST NAME / DATE
FAMILY ADDRESS / CONTACT INFORMATION
STREET ADDRESS / CITY, STATE, ZIP CODE / HOME PHONE NUMBER
FATHER INFORMATION
LAST NAME (IF DIFFERENT) / FIRST NAME / HOME PHONE (IF DIFFERENT) / WORK PHONE NUMBER
MAILING ADDRESS (IF DIFFERENT FROM FAMILY ADDRESS) / IS FATHER CATHOLIC?
MOTHER INFORMATION
LAST NAME (IF DIFFERENT) / FIRST NAME / HOME PHONE (IF DIFFERENT) / WORK PHONE NUMBER
MAILING ADDRESS (IF DIFFERENT FROM FAMILY ADDRESS) / MAIDEN NAME / IS MOTHER CATHOLIC?
OTHER ADULT (IF NOT MOTHER OR FATHER)
LAST NAME (IF DIFFERENT) / FIRST NAME / HOME PHONE (IF DIFFERENT) / WORK PHONE NUMBER
MAILING ADDRESS (IF DIFFERENT FROM FAMILY ADDRESS) / RELATIONSHIP TO CHILD(REN) / IS OTHER ADULT CAHTOLIC?
EMERGENCY CONTACT
LAST NAME / FIRST NAME / RELATIONSHIP TO CHILD(REN) / PHONE NUMBER
WITH WHOM DOES CHILD / DO CHILDREN RESIDE? / FATHER & MOTHER / FATHER / MOTHER / OTHER ADULT / (IF OTHER ADULT, FILL OUT ‘OTHER ADULT’ CONTACT INFORMATION ABOVE)
PERSON TO CONTACT ABOUT RELIGIOUS EDUCATION AND RELATED ACTIVITIES / FATHER & MOTHER / FATHER / MOTHER / OTHER ADULT / (IF OTHER ADULT, FILL OUT ‘OTHER ADULT’ CONTACT INFORMATION ABOVE)
PARISH AFFILIATION / OLGC / OTHER (PLEASE SPECIFY):
PRIVACY STATEMENT: ALL INFORMATION ENTERED ON THIS FORM IS CONSIDERED CONFIDENTIAL AND IS FOR THE SOLE USE OF THE RELIGIOUS EDUCATION PROGRAM AT OUR LADY OF GOOD COUNSEL CHURCH, ENDICOTT, NY. NO INFORMATION WILL BE RELEASED, IN WHOLE OR PART, WITHOUT THE EXPRESSED CONSENT OF THE EFFECTED PERSONS.
TUITION DONATION INFORMATION (RE OFFICE USE ONLY) / REGISTRATION DOCUMENTATION
DONATION / PARISHIONER / $15 PER CHILD OR $40 PER FAMILY (MAX) / IF ANY OF YOUR CHILDREN WERE BAPTIZED OUTSIDE OF OUR PARISH, AND YOU HAVE NOT GIVEN US A COPY OF THE BAPTISMAL CERTIFICATE, YOU NEED TO PROVIDE US A COPY FOR OUR FILES. THIS IS ESPECIALLY IMPORTANT FOR CHILDREN INVOLVED IN A SACRAMENTAL PREPARATION PROGRAM.
NON-PARISHIONER / $20 PER CHILD OR $50 PER FAMILY (MAX)
TUITION DUE / $ / TUITION RECEIVED / $
STUDENT RELIGIOUS EDUCATION REGISTRATION INFORMATION
FIRST NAME / LAST NAME (IF DIFFERENT) / SEX / BIRTH DATE / GRADE / 1ST CLASS CHOICE (DAY/TIME) / 2ND CLASS CHOICE (DAY/TIME)
SCHOOL: / MARK SACRAMENTS RECEIVED: / BAPTISM / EUCHARIST
RECONCILIATION / CONFIRMATION
SPECIAL NEEDS: MEDICAL, PHYSICAL, OR LEARNING DISABILITIES; FAMILY SITUATIONS
CHILD 2
FIRST NAME / LAST NAME (IF DIFFERENT) / SEX / BIRTH DATE / GRADE / 1ST CLASS CHOICE (DAY/TIME) / 2ND CLASS CHOICE (DAY/TIME)
SCHOOL: / MARK SACRAMENTS RECEIVED: / BAPTISM / EUCHARIST
RECONCILIATION / CONFIRMATION
SPECIAL NEEDS: MEDICAL, PHYSICAL, OR LEARNING DISABILITIES; FAMILY SITUATIONS
CHILD 3
FIRST NAME / LAST NAME (IF DIFFERENT) / SEX / BIRTH DATE / GRADE / 1ST CLASS CHOICE (DAY/TIME) / 2ND CLASS CHOICE (DAY/TIME)
SCHOOL: / MARK SACRAMENTS RECEIVED: / BAPTISM / EUCHARIST
RECONCILIATION / CONFIRMATION
SPECIAL NEEDS: MEDICAL, PHYSICAL, OR LEARNING DISABILITIES; FAMILY SITUATIONS
CHILD 4
FIRST NAME / LAST NAME (IF DIFFERENT) / SEX / BIRTH DATE / GRADE / 1ST CLASS CHOICE (DAY/TIME) / 2ND CLASS CHOICE (DAY/TIME)
SCHOOL: / MARK SACRAMENTS RECEIVED: / BAPTISM / EUCHARIST
RECONCILIATION / CONFIRMATION
SPECIAL NEEDS: MEDICAL, PHYSICAL, OR LEARNING DISABILITIES; FAMILY SITUATIONS
PLEASE PLACE A MARK IN THE BOX TO THE LEFT IF YOUR CHILD/CHILDREN ARE INTERESTED IN PARTICIPATING IN THE 9:30 MASS CHILDREN’S CHOIR (GRADE 2 AND ABOVE).
RELIGIOUS EDUCATION VOLUNTEERS
VOLUNTEERS MAKE OUR PROGRAM WORK. WE NEED YOU! PLEASE SEARCH YOUR HEART AND DECIDE WHERE GOD IS CALLING YOU TO SERVE. PARENTS AND GUARDIANS ARE ASKED TO VOLUNTEER TO DO AT LEAST ONE THING TO MAKE THIS PROGRAM WORK. HELP IS NEEDED IN THE FOLLOWING AREAS:
I WILL: / DAY / TIME / GRADE / I WILL HELP WITH:
TEACH – SERVE AS LEAD TEACHER FOR A CLASS / DECEMBER “JOY” PARTY
TEAM TEACH – SHARE TEACHING DUTIES WITH ANOTHER TEACHER / FAITHWAYS ACTIVITIES (GRADES 6, 7, 8)
SUBSTITUTE-TEACH – ALWAYS A NEED. LESSON PLANS WILL BE AVAILABLE / FAMILY FUN NIGHT & COVERED DISH DINNER
TEACHER’S AIDE IN ELEMENTARY PROGRAM – HELP TEACHER IN CLASSROOM / FIRST COMMUNION RECEPTION
HALL MONITOR IN ELEMENTARY PROGRAM – ROTATING SCHEDULE / BAKING
ADULT LEADER IN MIDDLE SCHOOL COMMUNITY SERVICE PROGRAM / Selected Events / YOUTH GROUP ACTIVITIES
ADULT LEADER IN HIGH SCHOOL COMMUNITY SERVICE PROGRAM / Selected Events / PLEASE CALL ME
VOLUNTEER NAME: / BEST TIME TO CALL: / PHONE NUMBER: