ST RICHARD PARISH PSR 2021-2022 Student Registration Form
Please fill out the form carefully for registration
Family Surname
*
How many children are you registering for 2021-2022 PSR?
*
Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number
*
Parent/Guardian E-mail
*
example@example.com
Secondary E-mail for Parent/Guardian (if applicable)
example@example.com
STUDENT INFORMATION
FIRST CHILD
Student Name
*
First Name
Last Name
Student Birth Date
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Place of Birth:
City, State
*
Church of Baptism (Please Include the Church Name and City/State)
*
PSR Grade Level for 2021-2022
*
Please Select
Kindergarten
1
2
3
4
5
6
7
8
School where child attends day-school
*
Are there any special needs or circumstances that you would like their catechist to know about?
SECOND CHILD
Student Name
First Name
Last Name
Student Birth Date
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Place of Birth:
City, State
Church of Baptism (Please Include the Church Name and City/State)
PSR Grade Level for 2021-2022
Please Select
Kindergarten
1
2
3
4
5
6
7
8
School where child attends day-school
Are there any special needs or circumstances that you would like their catechist to know about?
THIRD CHILD
Student Name
First Name
Last Name
Student Birth Date
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Place of Birth:
City, State
Church of Baptism (Please Include the Church Name and City/State)
PSR Grade Level for 2021-2022
Please Select
Kindergarten
1
2
3
4
5
6
7
8
School where child attends day-school
Are there any special needs or circumstances that you would like their catechist to know about?
FOURTH CHILD
Student Name
First Name
Last Name
Student Birth Date
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Place of Birth:
City, State
Church of Baptism (Please Include the Church Name and City/State)
PSR Grade Level for 2021-2022
Please Select
Kindergarten
1
2
3
4
5
6
7
8
School where child attends day-school
Are there any special needs or circumstances that you would like their catechist to know about?
FIFTH CHILD
Student Name
First Name
Last Name
Student Birth Date
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Place of Birth:
City, State
Church of Baptism (Please Include the Church Name and City/State)
PSR Grade Level for 2021-2022
Please Select
Kindergarten
1
2
3
4
5
6
7
8
School where child attends day-school
Are there any special needs or circumstances that you would like their catechist to know about?
SIXTH CHILD
Student Name
First Name
Last Name
Student Birth Date
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Place of Birth:
City, State
Church of Baptism (Please Include the Church Name and City/State)
PSR Grade Level for 2021-2022
Please Select
Kindergarten
1
2
3
4
5
6
7
8
School where child attends day-school
Are there any special needs or circumstances that you would like their catechist to know about?
PARENT/GUARDIAN INFORMATION
Name of Father
*
First Name
Last Name
Living/Deceased
*
Living
Deceased
Religion of Father
*
Roman Catholic
Other
Name of Mother
*
First Name
Last Name
Mother's Maiden Name
*
Living/Deceased
*
Living
Deceased
Religion of Mother
*
Roman Catholic
Other
Name of Guardian
First Name
Last Name
Religion of Guardian
Roman Catholic
Other
REGISTRATION FEE
Registration for Option 1 (in-person fall and spring semesters) is $100 for 1 child, $150 total for 2 children, or $200 total for 3 or more children. If you choose Option 2 (PSR-from-home for the year), that is $50 for 1 child, $75 total for two children, and $100 total for 3 or more children. Please make checks payable to: "St Richard Parish" and mail to: "PSR Coordinator" at 11223 Schuetz Road St Louis, MO 63146
Which option are you selecting for your family?
*
Option 1 (In-person classes for fall and spring semesters)
Option 2 (PSR-from-home for the entire PSR year)
Is your child new to PSR at St Richard's this year?
*
Yes, my child will begin attending a PSR program for the first time this year
Yes, my child is transferring from another parish school/PSR
No, we are a returning family
Is your family registered at St Richard Parish? (Families must be registered with the parish, but don't worry it's an easy process and we'd be happy to have you join us!)
*
Yes
No, but we'd like to be
I don't know
Submit Application
Clear Fields
Should be Empty: