Saint Mark the Evangelist CatholicChurch
ParishSchool of Religion
2017 - 2018Religious Education Registration
PLEASE USE BLACK INK –FILL OUT ONE COMPLETE FORM PER CHILD
Please PrintDATE ____/____/____
CHILD’S NAME:______, ______, ______
(Last) (First) (Middle name)
NAME CHILD GOES BY:______MALE ______FEMALE ______AGE ______
DATE OF BIRTH:____/____/____ GRADE ENTERING ______SCHOOL ATTENDING______
PARENT’S NAMES:mother______father______
FAMILY EMAIL ADDRESS (please provide, print clearly): ______
CHILD’S ADDRESS:______
(street)(city) (zip)
MAIN CONTACT PHONE:______MOTHER’s CELL ______FATHER’S CELL______
CHILD LIVES WITH: BOTH PARENTS ______MOTHER _____ FATHER ______GUARDIAN ______
MAIL SHOULD GO TO: BOTH PARENTS ______MOTHER _____ FATHER ______GUARDIAN ______
MOTHER’S ADDRESS IF DIFFERENT FROM CHILD’S:
______
(street)(city) (zip)
FATHER’S ADDRESS IF DIFFERENT FROM CHILD’S:
______
(street)(city) (zip)
PARISH CHILD’S FAMILY ATTENDS: ______
ARE YOU A REGISTERED MEMBER of ST. MARK the EVANGELISTCHURCH? Yes ______No ______
HEALTH INFORMATION
EMERGENCY CONTACT PERSON (other than parent): ______
(name)(phone)
IF PARENTS CANNOT BE CONTACTED IN CASE OF EMERGENCY, DO WE HAVE PERMISSION TO CONTACT THE CHILD’S PHYSICIAN?
Yes ______No ______
NAME OF PHYSICIAN: ______PHONE # ______
DO WE HAVE PERMISSION TO SEEK MEDICAL HELP? Yes ______No ______
PLEASE LIST ANY KNOWN ALLERGIES, HEALTH PROBLEMS, SPECIAL EDUCATIONAL, OR FAMILY CONCERNS FOR YOUR CHILD:
______
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CLASS DAYS AND TIMES (please check one and specify the grade)
GRADES K-4 SUNDAY 9:00 – 10:15 am ______
GRADES K-5 THROUGH 8 CLASSES WEDNESDAY 4:30 - 5:45 pm Gr______SUNDAY 9:00 – 10:15 am Gr______
GRADE 9SUNDAY 9:00 – 10:15 am ______
GRADES 10, 11 & 12 (RAP session)SUNDAY 9:00-10:15 am ______
(Over)
CHILD’S NAME ______GRADE ______
SIBLING(S) ______GRADE(S) ______
REGISTRATION FEES*
ONE CHILD: $70 ______TWO CHILDREN: $140 ______THREE OR MORE$210 ______
*Before June 15, 2017*
ONE CHILD: $50 ______TWO CHILDREN: $100 ______THREE OR MORE$150 ______
Please attach payment checks to register this child for Religious Education.
Checks should be made to St. Mark the Evangelist Catholic Church and may be mailedto P.O. Box 380396, Birmingham, Al 35238
RECORDS
*****PLEASE COMPLETE THE FOLLOWING INFORMATION FOR ALL STUDENTS –NEW AND RETURNING!
*** PLEASE NOTE: IF CHILD WAS NOT BAPTISED AT ST. MARK, A COPY OF THE BAPTISMAL CERTIFICATE MUST BE PROVIDED AT THE TIME OF REGISTRATION (if not previously turned in)
DATE OF BAPTISM: ____/____/____CHURCH: ______
City
DATE OF RECONCILIATION: ____/____/____CHURCH: ______
City
DATE OF FIRST EUCHARIST: ____/____/____CHURCH: ______
City
DATE OF CONFIRMATION: ____/____/____CHURCH: ______
City
HELP NEEDED
We have a need for Catechists, Substitutes or Assistants. If you are interested in becoming involved, please indicate the area and grade level. (Children of Catechists and Aids do not pay the yearly fees). Thank You!
Catechist:Grade 4K – Grade 5 ______
Grade 6 – 9 ______
Assistant:Grade 4K – Grade 5 ______
Grade 6 – 9 ______
Substitute:Grade 4K – Grade 5 ______
Grade 6 – 9 ______
AUTHORIZATION
PERSON(S) AUTHORIZED TO PICK UP CHILD FROM CLASS: ______
(name) (phone)
______
(name) (phone)
SIGNATURE OF PARENT/GUARDIAN COMPLETING THIS FORM: ______