PSR Registration Form

St. Francis of Assisi Parish

School of Religion

203 E. Main St.

Teutopolis, IL 62467

217-857-6477
PSR Registration Form

School Year 2022-23
Family Name:
Address

Address

Street Address Line 2

City
Phone Number

Area Code Phone Number
Cell Number

Area Code Phone Number
Email:
example@example.com
Student(s) live with

Both Parents Mother Father
Are you a registered member of St. Francis of Assisi Parish?

yes no
If No, what parish or Church are you registered with?
Parish
City
Child(ren) Names: Grade 1-12th
Child's Name: blanks
Child's Grade: blank
Church Baptized
School Child Attends:
Child's Name: blanks
Child's Grade: blank
Church Baptized
School Child Attends:
Child's Name: blanks
Child's Grade: blank
Church Baptized
School Child Attends:
Child's Name: blanks
Child's Grade: blank
Church Baptized
School Child Attends:
Child's Name: blanks
Child's Grade: blank
Church Baptized
School Child Attends:
I want my child/children to participate in the Religion Program.(type yes or no) (The children will receive a text to use and other materials.) Bills for these materials are $40 per child or a $100 maximum per family yearly to be paid to St. Francis Church, 203 E Main St, Teutopolis, IL 62467 by the end of November if possible.
I want my child/children to be supervised from 7:15 am - 7:50 am by the St. Francis Religious Education Program volunteers. (type yes or no)
blankI want my child/children to receive the sacraments with St. Francis of Assisi Parish. If your child was not baptized in St. Francis of Assisi Church, we neeed a copy of the child's baptismal certificate or record. (type yes or no)
PERSONAL SAFETY TRAINING--The Office of Child and Youth Protection in Washington, DC requires safe environment training for children in religious education programs. We will be using videos provided by the diocese during regularly scheduled religion classes to communicate the tips on keeping our children safe. This is required training each year for the children. Each class has a scheduled day to view the videos. Parents are always welcome to view the videos with their child. Please read the following questions carefully and check those that apply.

I would like to view the videos with my children I give my permission for my child(ren) to participate in the Personal Training Session. I do not give permission for my child(ren) to participate in the Personal Safety Training Session.
The following child(ren) will not participate in the Personal Training Sessions: blanks , blank
(Parent/Guardian Signature)

Clear
(Date)

Month Day Year
Date
Please note: If your grade 1 child was baptized in another parish other than St. Francis, please forward to us a copy of the Baptismal record. If you cannot locate the Baptismal record, please contact the parish of your child’s Baptism, and request a copy of the Baptismal record to be forwarded to St. Francis Religious Education Office. We will in turn make a copy for our records and mail the original record back to you. As always, thanks for your cooperation.
Medical Information:
If your child has any medical or special health issues we should know about, please list the child’s name and information about the condition.
Child: blanks Condition: blank
Child: Condition:
Child: Condition:
Emergency Contact:

In case of an emergency, who else could we contact if you are unavailable?
Contact: blanks Phone: Phone Number
Contact: Phone: Phone Number
Photo Consent:

We may take pictures on occasion, if so we need your permission.
I give my permission for my child(ren)’s photo to be taken and used for ministry or publicity purposes.
Volunteer to Help:

For a program that uses volunteers to be successful we are still in need of help. If you can help please indicate the way you can help by filling out the spaces below.
Grade School Morning Building Supervision: 7:15-7:50 a.m.
Monday Tuesday Wednesday Thursday Friday
Grade 1-6 Teaching or Walking Students: 7:50-8:45 a.m.
Teach Mass/Video Walker Gospel Sub
Monday Tuesday Wednesday Thursday Friday
Grade 7 and 8 Help 7:20-8:30 p.m. Wednesday—September to April:
Teach full year Teach one semester Hall Monitor (monthly)
High School Help 7:20-8:30 p.m. Wednesday—September to April:
Teach full year Teach one semester Hall Monitor (monthly)
All volunteers need to have taken “Protecting God’s Children” class.
Should be Empty:

PSR Registration Form

Medical Information:

Emergency Contact:

Photo Consent:

Volunteer to Help: