2022-23 PSR Registration

Assumption PSR Registration (Grades 1 - 8)
Please register each child separately.

Families new to Assumption PSR must provide a copy of Baptismal Certificate for each child registered.

PSR Tuition is $60.00 and classes will begin Monday - September 12, 2022.

Please note: to register for the Pre-K PSR program, please click here. This will redirect you to the Pre-K registration portal.
Student Information
Name

First Name Last Name
Last Grade Completed
Birth Date

Month Day Year
Place of Birth
City / State of Birth
Doctor for Emergency
Phone Number for Doctor
Health Issues / Special Needs
BAPTISM: Date / Church / City & State
1ST COMMUNION: Date / Church / City & State
CONFIRMATION: Date / Church / City & State
Family Information
Family Last Name
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cell Phone Number (Mother)

Area Code Phone Number
Cell Phone Number (Father)
Please enter a valid phone number.

Emergency Contact Person
Name

First Name Last Name
Relationship
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Father's Information:
Father's Name

First Name Last Name
Religion
Baptized: (Yes / No) and Church?
1st Communion: (Yes / No) and Church?
Confirmed: (Yes / No) and Church?
Mother's Information:
Mother's Name

First Name Last Name
Religion
Baptized: (Yes / No) and Church?
1st Communion: (Yes / No) and Church?
Confirmed: (Yes / No) and Church?
Marital Status
If divorced, who has legal custody?

Please pay for each child's PSR registration separately. Thank you!
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PSR Registration
$ 60.00 Quantity

Total

$ 0.00
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