2020-2021 PSR Registration

2022-2023 St. Clement PSR Registration

Please complete this form in its entirety to successfully register your family for St. Clement's Parish School of Religion.
GENERAL INFORMATION
Family Surname(s) *
Last Name
How many children are you registering for 2022-2023 PSR? *
What parish are you registered in? *

St Clement of Rome
Child(Children) live(s) with - *

Both Parents Together Mother Father Guardian
Current Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
STUDENT INFORMATION
FIRST CHILD

The child you list as First Child will be considered "Oldest/Only" in our database and, when given, will be the child to receive information to be brought home.
Child's Legal Name *

First Name Last Name Nickname (if applicable)
Child's Birth Date *

Month Day Year
Date
Gender
Schools Attended *
Please list Elementary and Middle Schools
PSR Grade Level for 2022-2023 *
What would you like us to know about your child to help PSR staff in meeting your child's medical, emotional, or learning needs. *
Information will be kept confidential.
SECOND CHILD
Child's Legal Name *

First Name Last Name Nickname (if applicable)
Child's Birth Date *

Month Day Year
Date
Gender
Schools Attended *
Please list Elementary and Middle Schools
PSR Grade Level for 2022-2023 *
What would you like us to know about your child to help PSR staff in meeting your child's medical, emotional, or learning needs. *
Information will be kept confidential.
THIRD CHILD
Child's Legal Name *

First Name Last Name Nickname (if applicable)
Child's Birth Date *

Month Day Year
Date
Gender
Schools Attended *
Please list Elementary and Middle Schools
PSR Grade Level for 2022-2023 *
What would you like us to know about your child to help PSR staff in meeting your child's medical, emotional, or learning needs. *
Information will be kept confidential.
FOURTH CHILD
Child's Legal Name *

First Name Last Name Nickname (if applicable)
Child's Birth Date *

Month Day Year
Date
Gender
Schools Attended *
Please list Elementary and Middle Schools
PSR Grade Level for 2022-2023 *
What would you like us to know about your child to help PSR staff in meeting your child's medical, emotional, or learning needs. *
Information will be kept confidential.
FIFTH CHILD
Child's Legal Name *

First Name Last Name Nickname (if applicable)
Child's Birth Date *

Month Day Year
Date
Gender
Schools Attended *
Please list Elementary and Middle Schools
PSR Grade Level for 2022-2023 *
What would you like us to know about your child to help PSR staff in meeting your child's medical, emotional, or learning needs. *
Information will be kept confidential.
Child's Birth Date *

Month Day Year
Date
Gender
Schools Attended *
Please list Elementary and Middle Schools
PARENT/GUARDIAN INFORMATION

The following information is needed for our database and the student's permanent and Sacramental records.
Name of Father

First Name Last Name
Living/Deceased

Living Deceased
Religion of Father

Roman Catholic
Marital Status of Father
Name of Mother

First Name Last Name Maiden Name
Living/Deceased

Living Deceased
Religion of Mother

Roman Catholic
Marital Status of Mother
Name of Guardian

First Name Last Name
Religion of Guardian

Roman Catholic
Additional Parent Information:
CONTACT INFORMATION

Please submit the parents'/guardians' contact information.
Primary Phone Number *

Area Code Phone Number
Whose Phone Number is this? *

Mom Dad Guardian
Secondary Phone Number

Area Code Phone Number
Whose Phone Number is this?

Mom Dad Guardian
Primary Email *
Secondary Email
Emergency Contact 1 (other than parent/guardian listed above) *
First and Last Name, Relationship to Student(s)
Emergency Contact 1 Phone Number *

Area Code Phone Number
Emergency Contact 2 (other than parent/guardian listed above)
First and Last Name, Relationship to Student(s)
Emergency Contact 2 Phone Number

Area Code Phone Number
ARRIVAL & DISMISSAL

Students must be signed into their classroom upon arrival. Class starts at 6:00pm. Dismissal will be at 7:15pm and students must be picked up by their parent/guardian from their teacher and signed out.
Dismissal Request
MEDIA AUTHORIZATION

For marketing and publicity purposes, there may be times when the school/parish wishes to use your and/or your child(ren)’s image, name, recording, or academic work in various media for marketing and/or publicity purposes. Our purpose for asking is to mainly use in the bulletin and on the website. As a parent, you may grant or deny authorization.
I grant permission to use my or my child(ren)’s image, name, recording, or academic work in communications that include, but are not limited to, the parish bulletin, school newsletter, parish/school website and social media.

Yes No
REGISTRATION FEE
Registration is $125 per child and ends July 31st. Any registrations after July 31st are subject to a $25 dollar late fee (receiving registrations early allows us to prepare for the year, such as ordering books and materials).

Invoices will be sent out in August.
Upon receiving your invoice, please make checks payable to

"St. Clement of Rome Church"

and mail to:

Sue Cunningham PSR Director
1510 Bopp Rd
St. Louis, MO 63131.
SACRAMENTAL INFORMATION

We require registrants to provide sacramental information for their child who will be new to PSR this year. If so please indicate below. If you are returning to PSR please know that we may contact you to update your child's sacramental information. Thank you!
PSR Status *

My child(ren) will be new to PSR this year. We are returning and understand we may be asked for sacramental information.
Baptism (date / parish / city) *
Please mail in a copy of the Baptismal Certificate if NOT baptized at St. Clement
First Penance (date / parish / city)
First Eucharist (date / parish / city)
PARENT PARTICIPATION

Parents are the life breath to successful faith formation! We have a number of ways for you to be involved beyond the formation you provide at home.
Catechist: acts as the faith educator/teacher in the classroom and receives a small stipend. Registration Fee is waived.

Catechists must go through Protecting God's Children, have a background check and sign a Code of Ethical Conduct.
Please indicate your preference to help in the following areas:

Catechist
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2022-2023 St. Clement PSR Registration

GENERAL INFORMATION

STUDENT INFORMATION

FIRST CHILD

SECOND CHILD

THIRD CHILD

FOURTH CHILD

FIFTH CHILD

PARENT/GUARDIAN INFORMATION

CONTACT INFORMATION

ARRIVAL & DISMISSAL

MEDIA AUTHORIZATION

REGISTRATION FEE

SACRAMENTAL INFORMATION

PARENT PARTICIPATION