Registration

Online Registration (PayPal Enabled)

New & Returning Students 2022-2023
Student(s) Information
Student(s) Last Name

Child(ren) and Sacrament(s) Received:*

Rows	Name	Gender	Grade	Attended last year?	Birth Date	Baptism	Holy Communion
Child #1
Child #2
Child #3
Child #4

New or Returning Student in need of BaptismNew or Returning Student in need of First Holy Communion (1st-7th grades) must have at least two years of continuous formation before admittance to First Holy Communion.
Notes
Use this note box to include other important notes for us, if needed.
PARENT/GUARDIAN INFORMATION:
Father's Name*

First NameLast Name
Cell Phone #*

Area CodePhone Number
Mother's Name*

First NameLast Name
Cell Phone #*

Area CodePhone Number
Family E-mail*
YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact
Contact Name*

First NameLast Name
Relation to Student
Cell Phone #*

Area CodePhone Number
Adults allowed to pickup student: (not applicable in a distance learning year):
MEDICAL INFORMATION
Primary Doctor

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Concerns
Insurance Company
Card A/O Group #
Parent Signature
YesNo
YES - I CAN make such video conferencing applications (e.g., Zoom) available to my child under my supervision)NO - I CANNOT make such video conferencing applications (e.g., Zoom) available to my child under my supervision)
By signing below, I request the above-named participant be allowed to attend church-related activities with the St Dominics Catholic church. I, the parent/guardian of the above-named student do hereby give permission for him/her to attend Faith Formation/Sacramental Preparation Classes and to be treated for a medical emergency in my absence while participating in the faith formation program. The adult supervisor may act as an agent in my absence.
Name Signing

First NameLast Name
Signature

Clear
Date

MonthDayYear
Date
Forms Needed For New Students:

Each of following forms/certificates needs to be submitted:
New families are asked to complete a New Family Registration form.

Please download this form, fill out and upload in Family Registration field below:

New Parishioner Registration Form (pdf)
New Parishioner Registration Form

Browse Files
1 per family Cancelof
Child's Birth Certificate (s)

Browse Files
You can add more than one certificate at a time if more than 1 child. (up to 4 files) Cancelof
Baptism Certificate (s)

Browse Files
You can add more than one certificate at a time if more than 1 child. (up to 4 files) Cancelof
Holy Communion Certificate(s) - if any.

Browse Files
You can add more than one certificate at a time if more than 1 child. (up to 4 files) Cancelof
Payment

By clicking Submit, your registration will be directed to PayPal for payment. Paypal is a service that enables you to pay, send money, and accept payments. Register your credit card or debit card with your PayPal account and make your registration experience easier than ever!
For more than 1 student please calculate fees and enter below.

Fees:

- Base Tuition $90 (per student)

- Sacrament Tuition $30 (only additive in a sacrament year)

- Teacher's Child(ren): Fee Waived

- Teacher's Aide: 50% Fee Waived

(example: Student 1 first Grade ($90) + Student 2nd grade plus holy Communion ($90+$30) + Student 3 6th Grade ($90) = 90 + 120 + 90 = $300
Enter Amount Total:

prevnext( X )
USD$90 Fee for Faith Formation per Child.
Should be Empty:

Online Registration (PayPal Enabled)

Student(s) Information

PARENT/GUARDIAN INFORMATION:

Emergency Contact

MEDICAL INFORMATION

Parent Signature

Forms Needed For New Students:

Payment