Our Lady of the Blessed Sacrament Parish

OUR LADY OF THE BLESSED SACRAMENT RELIGIOUS EDUCATION

P.O. BOX 489, WESTFIELD, MA 01086

REGISTRATION 2016 – 2017

$48per child for students who are not in Sacramental years.

$78for students in First Eucharist (2nd grade)

$78 for Confirmation students

** Online payment available for an additional $2 per student at

( Please print clearly)

STUDENT’S FIRSTNAME ______MIDDLE:______LAST: ______

STUDENT’S ADDRESS: ______HOME PHONE: ______

GRADE IN SEPTEMBER______DATE OF BIRTH ______CELL PHONE: ______CHECK TO RECEIVE

UPDATES BY TEXT MSG.

STUDENT’S EMAIL ADDRESS (Middle/High School)______

WHERE WAS CHILD BAPTIZED:______

(Church, City and State)

New students must provide a baptismal certificate, if not baptized at Our Lady of the Blessed Sacrament.

DOES YOUR CHILD HAVE ANY LEARNING NEEDS, HEALTH PROBLEMS, ALLERGIES, MEDICATIONS OR CUSTODY ISSUES

THAT WE SHOULD KNOW ABOUT? Y N

IF YES, PLEASE LIST______

FATHER’S FIRSTNAME ______MIDDLE: ______LAST:______

HOME PHONE (if different): ______CELL NO. ______CHECK TO RECEIVE

UPDATES BY TEXT MSG.

FATHER’S ADDRESS (if different) ______

FATHER’S EMAIL ADDRESS ______

MOTHER’S FIRST NAME______MIDDLE:______LAST:______

MAIDEN NAME: ______HOME PHONE(if different): ______

MOTHER’S ADDRESS (if different)______CELL NO:______CHECK TO RECEIVE

UPDATES BY TEXT MSG.

MOTHER’S EMAIL ADDRESS ______

WITH WHOM DOES CHILD RESIDE? Mother ___ Father ___ BOTH ___ OTHER______

Please note any special circumstances we should know about and additional contact information we should have:

______

WE ARE REGISTERED AT - OLBS _____OTHER ______

PARENT SIGNATURE ______

** EMERGENCY CONTACT NAME (other than parents/guardian): ______

PHONE NUMBER(S): ______RELATIONSHIP: ______

PLEASE COMPLETE REVERSE SIDE FOR ADDITIONAL CHILDREN

CAN YOU HELP WITH OUR PROGRAM?

Catechist (Teacher – grade?) ______Catechist (Aide – grade?) ______Substitute Catechist (grade?)______

Elem. Dismissal Helper _____Weekly Office Help _____Special projects help _____

STUDENT’S FIRST NAME ______MIDDLE:______LAST: ______

STUDENT’S ADDRESS(if different): ______HOME PHONE (if different): ______

GRADE IN SEPTEMBER______DATE OF BIRTH ______CELL PHONE: ______CHECK TO RECEIVE

UPDATES BY TEXT MSG.

STUDENT’S EMAIL ADDRESS(Middle/High School)______

WHERE WAS CHILD BAPTIZED:______

(Church, City and State)

New students must provide a baptismal certificate, if not baptized at Our Lady of the Blessed Sacrament.

DOES YOUR CHILD HAVE ANY LEARNING NEEDS, HEALTH PROBLEMS, ALLERGIES, MEDICATIONS OR CUSTODY ISSUES THAT WE SHOULD KNOW ABOUT? Y N

IF YES, PLEASE LIST______

STUDENT’S FIRST NAME ______MIDDLE:______LAST: ______

STUDENT’S ADDRESS(if different): ______HOME PHONE (if different): ______

GRADE IN SEPTEMBER______DATE OF BIRTH ______CELL PHONE: ______CHECK TO RECEIVE

UPDATES BY TEXT MSG.

STUDENT’S EMAIL ADDRESS(Middle/High School)______

WHERE WAS CHILD BAPTIZED:______

(Church, City and State)

New students must provide a baptismal certificate, if not baptized at Our Lady of the Blessed Sacrament.

DOES YOUR CHILD HAVE ANY LEARNING NEEDS, HEALTH PROBLEMS, ALLERGIES, MEDICATIONS OR CUSTODY ISSUES THAT WE SHOULD KNOW ABOUT? Y N

IF YES, PLEASE LIST______

STUDENT’S FIRST NAME ______MIDDLE:______LAST: ______

STUDENT’S ADDRESS(if different): ______HOME PHONE (if different): ______

GRADE IN SEPTEMBER______DATE OF BIRTH ______CELL PHONE: ______CHECK TO RECEIVE

UPDATES BY TEXT MSG.

STUDENT’S EMAIL ADDRESS(Middle/High School)______

WHERE WAS CHILD BAPTIZED:______

(Church, City and State)

New students must provide a baptismal certificate, if not baptized at Our Lady of the Blessed Sacrament.

DOES YOUR CHILD HAVE ANY LEARNING NEEDS, HEALTH PROBLEMS, ALLERGIES, MEDICATIONS OR CUSTODY ISSUES THAT WE SHOULD KNOW ABOUT? Y N

IF YES, PLEASE LIST______