OUR LADY OF PERPETUAL HELP
FAITH FORMATION OF YOUTH

*Gr.K-5 Please indicate choice of day:

 

_____

Sun. 10:15 - 11:30 am
   

_____

Thurs. 4:15 - 5:30 pm

Family Registration Form

  

_____

Either Sun. or Thurs.
 

*Gr. 1 - 6:

2008 - 2009

  

_____

Home Study Program

 

Parent Information:

  

 

Family Last Name:

    

Registered in:

  

(Parish)

  

 

Address:

            

Street

City

Zip

 

Phone #:

  

 

Home

Mother’s cell

Mother's Work #

 

Father's Work #

  

 

Father/Guardian:

            

 

First & Last Name

    

Occupation

Religion

  
 

           
 

Mother/Guardian:

            

 

First & Last Name

  

Maiden Name

Occupation

Religion

  
 

           
 

Computer Information:

  
 

     

Catholic High School Students:

  

 

Name of Person

E-Mail Address

Name

Grade

Large Group Activities ONLY

  

 

Home Environment (Information . is considered confidential) PLEASE CHECK ALL SITUATIONS THAT APPLY:

  
 

_____ Parents

_____ Divorced

_____ Joint Custody

_____ Father Deceased

  
 

_____ Married

_____ Mother Remarried

_____ Single Parent Home

_____ Legal Guardian

  
 

_____ Separated

_____ Father Remarried

_____ Mother Deceased

_____ Foster Parent/s

  
 

           
 

Stepfather:

            

 

First & Last Name

Is child(ren) living with this person?

Occupation

Religion

  
 

           
 

Stepmother:

            

   

First & Last Name

Is child(ren) living with this person?

Occupation

Religion

  
 

           

 

Children's Information:

  
 

           
 

# 1 Child's Name:

      

Date of Birth

    /    /        

  

 

           
 

Place of Birth:

Sex:

Male

Female

Age:

Grade level:

  

 

           
 

Name of Public School:

Any previous Religious Education?

Yes

No

  

 

           
 

If yes, where?  Church:

  

City and State:

      

 

           
 

Religious Ed. level this year - (may be different from school level)

Comments:

  

 

           
 

Sacraments Received:

Baptism

  

First Eucharist

Date:    /    /        

Confirmation

Date:    /    /        

  

 

yes / no

  

yes / no

  

yes / no

    
 

           

 

Children's Information:

  
 

           
 

# 2 Child's Name:

      

Date of Birth

    /    /        

  

 

           
 

Place of Birth:

Sex:

Male

Female

Age:

Grade level:

  

 

           
 

Name of Public School:

Any previous Religious Education?

Yes

No

  

 

           
 

If yes, where?  Church:

  

City and State:

      

 

           
 

Religious Ed. level this year - (may be different from school level)

Comments:

  

 

           
 

Sacraments Received:

Baptism

  

First Eucharist

Date:    /    /        

Confirmation

Date:    /    /        

  

 

yes / no

  

yes / no

  

yes / no

    
 

           
 

# 3 Child's Name:

      

Date of Birth

    /    /        

  

 

           
 

Place of Birth:

Sex:

Male

Female

Age:

Grade level:

  

 

           
 

Name of Public School:

Any previous Religious Education?

Yes

No

  

 

           
 

If yes, where?  Church:

  

City and State:

      

 

           
 

Religious Ed. level this year - (may be different from school level)

Comments:

  

 

           
 

Sacraments Received:

Baptism

  

First Eucharist

Date:    /    /        

Confirmation

Date:    /    /        

  

   

yes / no

  

yes / no

  

yes / no

    
 

           

 

Emergency Information:
In case of emergency and parents/guardians cannot be reached, please contact:

  
 

           
 

Full Name:

            

 

   

Relationship

Home Phone #

Work Phone #

  
 

           
 

- OR -

  
 

 
 

Full Name:

            

       

Relationship

Home Phone #

Work Phone #

  
 

 
 

I hereby authorize OLPH Religious Education personnel to obtain
Emergency Medical Treatment for my child if I cannot be reached.

  
 

           
 

Parent/Guardian Signature

    

Date

    

 

           

 

Special Comments:
Please note any learning disabilities, recent change in family situation, medical condition, etc. which might help us in ministering
to your family and serve the needs of your child(ren).

  
 

           
 

           

 

           

 

           

 

           

 

OFFICE USE ONLY

  
 

           
 

Total amount fees due:

          

 

           
 

Fees received -

Amount:

Cash

Check #

Date:

Bal.

Clerk:

  

 

           
 

Comments: