PSR Registration 2024-2025

PSR Registration - Fall 2024-2025
If you are enrolling a child in PSR at St. Basil for the first time, complete a Permanent Record Card found on the website at basilthegreat.org/psr. It is a .pdf you can fill out, save, and email to psr@basilthegreat.org. Alternatively, you could print it out and mail it in or drop it off.

Please complete this form for all children that you are registering for Fall PSR 2024 -2025. We are committed to a maximum class size of twenty students in grades 1 – 8, so a prompt response will be the best way to get your first choice session, since the registration is processed on a first-come basis.

Choose from one of the following options:
- Sunday morning 10:15am – 11:30am for Grades 1-3* (2nd and 3rd grades are full on Sunday)
- Monday evening 6:15pm – 7:30pm for Grades 1-8
- Tuesday evening 6:15pm – 7:30pm for Grades 1-5
- Family Catechesis Grades 1 – 8
Family Catechesis: Parents will walk with their child through the topics in their Faith Formation. Parents are invited to participate in FIVE meetings throughout the year for training and support as they serve as the child’s catechist. A schedule of all the meetings throughout the year will be distributed at the first meeting on Sunday, September 22nd at 10:30am or Tuesday September 24th at 6:30pm.

IMPORTANT DATES:
- Grades 1 – 3: Sunday, September 8, 2024 First class/ Parent Meeting
- Grades 1 – 8: Monday, September 9, 2024 First class/Parent Meeting
- Grades 1 – 5: Tuesday, September 10, 2024 First class/Parent Meeting
If you have any questions, please do not hesitate to call the PSR Office at 440-526-3520 or email Andrea Wasinski, Parish Catechetical Leader, awasinski@basilthegreat.org
Family Name*
Primary Contact Name*

First NameLast Name
Primary Contact Email*
Primary Contact Phone Number*
Please enter a valid phone number.
I am willing to volunteer my time:

In the office on the day/time that my child attends PSR. (answering phones, making copies, etc.)In my child's classroom as needed by the catechist.In the office during the day. (helping to prepare materials for meetings and sacraments, etc.)
Secondary Contact Name

First NameLast Name
Secondary Contact Email (if secondary contact would like to receive notices)
example@example.com
Secondary Contact Phone Number
Please enter a valid phone number.
I am willing to volunteer my time:

In the office on the day/time that my child attends PSR. (answering phones, making copies, etc.)In my child's classroom as needed by the catechist.In the office during the day. (helping to prepare materials for meetings and sacraments, etc.)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How many students are you registering?

1234
If you are registering more than 4 students, please call the office.
Student 1 Full Name*
Student 1 Grade*

1st2nd3rd4th5th6th7th8th
Student One Day/Time Preference*

Sunday 10:15 - 11:30am - Grade 1 ONLY (2nd & 3rd grades are full)Monday 6:15 - 7:30pm - Grades 1-8Tuesday 6:15 - 7:30pm - Grades 1-5Family Catechesis - Grades 1-8
Emergency Medical Authorization Form for Student 1

St. Basil Parish School of Religion
Student 1 Age*
Student 1 Birthdate*
Student 1 Gender*

MaleFemale
Student 1 Parent/Guardian Names*
Student 1 Parent Cell phone*
Student 1 Doctor Name*
Student 1 Doctor phone*
Student 1 Dentist Name*
Student 1 Dentist phone*
Student 1 Hospital of Choice*
Student 1 Hospital of Choice phone *
Student 1 Insurance Provider*
Student 1 Insurance Provider phone*
Please list any medical issues or concerns for Student 1
Please list any medical allergies for Student 1
Are there any activities in which Student 1 may NOT participate?
Student 1 Emergency Contact #1 Name*
Student 1 Emergency Contact #1 Phone*
Student 1 Emergency Contact #2 Name*
Student 1 Emergency Contact #2 Phone*
Student 2 Full Name*
Student 2 Grade*

1st2nd3rd4th5th6th7th8th
Student Two Day/Time Preference*

Sunday 10:15 - 11:30am - Grade 1 ONLY (2nd & 3rd grades are full)Monday 6:15 - 7:30pm - Grades 1-8Tuesday 6:15 - 7:30pm - Grades 1-5Family Catechesis - Grades 1-8
Emergency Medical Authorization Form for Student 2

St. Basil Parish School of Religion
Student 2 Age*
Student 2 Birthdate*
Student 2 Gender*

MaleFemale
Student 2 Parent/Guardian Names*
Student 2 Parent Cell phone*
Student 2 Doctor Name*
Student 2 Doctor's phone*
Student 2 Dentist Name*
Student 2 Dentist phone*
Student 2 Hospital of Choice*
Student 2 Hospital of Choice phone *
Student 2 Insurance Provider*
Student 2 Insurance Provider phone*
Please list any medical issues or concerns for Student 2
Please list any medical allergies for Student 2
Are there any activities in which Student 2 may NOT participate?
Student 2 Emergency Contact #1 Name*
Student 2 Emergency Contact #1 Phone*
Student 2 Emergency Contact #2 Name*
Student 2 Emergency Contact #2 Phone*
Student 3 Full Name*
Student 3 Grade*

1st2nd3rd4th5th6th7th8th
Student Three Day/Time Preference*

Sunday 10:15 - 11:30am - Grade 1 ONLY (2nd & 3rd grades are full)Monday 6:15 - 7:30pm - Grades 1-8Tuesday 6:15 - 7:30pm - Grades 1-5Family Catechesis - Grades 1-8
Emergency Medical Authorization Form for Student 3

St. Basil Parish School of Religion
Student 3 Age*
Student 3 Birthdate*
Student 3 Gender*

MaleFemale
Student 3 Parent/Guardian Names*
Student 3 Parent Cell phone*
Student 3 Doctor Name*
Student 3 Doctor's phone*
Student 3 Dentist Name*
Student 3 Dentist phone*
Student 3 Hospital of Choice*
Student 3 Hospital of Choice phone *
Student 3 Insurance Provider*
Student 3 Insurance Provider phone*
Please list any medical issues or concerns for Student 3
Please list any medical allergies for Student 3
Are there any activities in which Student 3 may NOT participate?
Student 3 Emergency Contact #1 Name*
Student 3 Emergency Contact #1 Phone*
Student 3 Emergency Contact #2 Name*
Student 3 Emergency Contact #2 Phone*
Student 4 Full Name*
Student 4 Grade*

1st2nd3rd4th5th6th7th8th
Student Four Day/Time Preference*

Sunday 10:15 - 11:30am - Grade 1 ONLY (2nd & 3rd grades are full)Monday 6:15 - 7:30pm - Grades 1-8Tuesday 6:15 - 7:30pm - Grades 1-5Family Catechesis - Grades 1-8
Emergency Medical Authorization Form for Student 4

St. Basil Parish School of Religion
Student 4 Age*
Student 4 Birthdate*
Student 4 Gender*

MaleFemale
Student 4 Parent/Guardian Names*
Student 4 Parent Cell phone*
Student 4 Doctor Name*
Student 4 Doctor's phone*
Student 4 Dentist Name*
Student 4 Dentist phone*
Student 4 Hospital of Choice*
Student 4 Hospital of Choice phone *
Student 4 Insurance Provider*
Student 4 Insurance Provider phone*
Please list any medical issues or concerns for Student 4
Please list any medical allergies for Student 4
Are there any activities in which Student 4 may NOT participate?
Student 4 Emergency Contact #1 Name*
Student 4 Emergency Contact #1 Phone*
Student 4 Emergency Contact #2 Name*
Student 4 Emergency Contact #2 Phone*
Grant of Consent

Sign directly below if you wish to grant consent
1.        I understand what is involved in the Activity and acknowledge that I have had the opportunity to ask questions regarding the scope and nature of the Activity. I recognize the possibility and risk of injury associated with my child(ren)’s participation in the Activity and that such injury can include, but is not limited to, pain, suffering, serious bodily injury, psychological injury, temporary or permanent disability, temporary or permanent paralysis, illness, disfigurement, further injury by medical treatment, and/or death. I understand that such injuries can occur for any number of reasons which are both foreseeable and unforeseeable and which include, but are not limited to, my child’s own actions or inaction, the actions or inaction of others (whether negligent, intentional, or otherwise), and equipment failure.

2.         I further understand that my child(ren)’s participation in the Activity is purely voluntary and is a privilege and not a right, and that my child(ren), and I on behalf of my child(ren), agree to my child(ren)’s participation in the Activity in spite of the risks. I and my spouse assume, for ourselves and on behalf of our minor child(ren), all risks in connection with my child(ren)’s participation in the Activity.

3.         I agree to instruct my child(ren) to cooperate with those persons in charge of the activity. I understand and agree that, in the event my child(ren) does not cooperate with the person(s) in charge of the activity, which shall be determined at the sole discretion of the person(s) in charge of the activity, I agree to cooperate with the Parish in picking up my child(ren) to remove them from the activity.

4.         To the fullest extent allowed by law, I, on behalf of myself, my spouse, my minor child(ren), as well as our respective heirs and assigns, executors, all other legal representatives and any others claiming through us or on behalf of us, hereby agree to release, discharge, hold harmless and indemnify the Parish, the Catholic Diocese of Cleveland, the Bishop or Administrator of the Catholic Diocese of Cleveland, as well as their respective clergy, officers, employees, agents, representatives, attorneys, sponsors, and volunteers (“Released Parties”) forever from and against any and all claims, lawsuits, damages, judgments, expenses including attorney’s fees, liabilities (of any nature or extent), demands, damages, cause of action of any nature and kind, known or unknown, which in any way arise out of or relate to my child(ren)’s participation in the Activity (including without limitation any injury, loss, or damage to my child’s person or property), whether foreseen or unforeseen, regardless of the cause (including, but not limited to, the negligence of any person) (the “Claims”).

5.         I understand that it is my responsibility to carry appropriate medical insurance for my child(ren) and that such is not the responsibility of any other person or party, including, without limitation, the Parish or the Diocese of Cleveland.

6.         In the event reasonable attempts to contact me at the number listed below have been unsuccessful, I hereby authorize any of the staff, employees, volunteers, agents and/or representatives of the Parish to provide for, seek, and authorize medical treatment for my child(ren) in the case of illness or accident from the closest and most appropriate licensed medical practitioner or hospital available. I understand that this authorization does not cover major surgery unless the medical opinions of two licensed physicians/dentists concurring in the necessity for such surgery are obtained for the performance of such surgery.
Please select one to grant or refuse consent for medical treatment:*

I grant consent for medical treatment of my child(ren)I refuse consent for medical treatment of my child(ren)
Signature for Consent

Clear
REFUSAL of Consent

Only sign below if you refuse consent and did not sign above, granting consent.
In the event of illness or emergency treatment being required, I wish the school authorities to take no action or to:
Signature for Refusal

Clear
PHOTO RELEASE
I consent and grant permission for the Parish and/or its agents to record (in writing or otherwise), photograph, audio record, and video record my minor child(ren)’s name, image, likeness, spoken words, in any form (the “Recordings”), and to display, release, exhibit, publish, or distribute the Recordings, or any part thereof, for the purpose of and in connection with any material that may be created by or on behalf of the Parish including, without limitation, through the Parish’s bulletin boards, social media, website, print and electronic media, marketing publications, public relations and communications materials and/or presentations, and any other uses as may not be contemplated herein, without further notice or compensation, and I agree that the Recordings shall constitute the sole property of the Parish. I further agree to release the Parish, the Catholic Diocese of Cleveland, and the Bishop of the Diocese of Cleveland, and their respective officers, directors, agents, employees and/or attorneys from and against any and all liability, loss, damage, costs, claims, and/or causes of action arising out of or related to the above items to which I have consented. I further understand that the Parish and its respective officer, directors, agents and/or employees have no control over use of photographs, videotapes, audiotapes, or other records made by others and/or outside the scope of this consent and release.
Do you give consent for an occasional photo to be taken*

I give consentI refuse consent
Signature*

Clear
To Pay by Credit Card

PLEASE READ CAREFULLY:

After checking the appropriate box below to choose the number of registrations and clicking "Register and Continue to Payment", you will be taken to the payment process.

You do not need to have or create a Paypal account. Simply click on "Pay with Debit or Credit Card" at the bottom and complete payment.
To Pay by Check or Cash

PLEASE READ CAREFULLY:

Choose the appropriate registration box below, then insert the promo code CHECK in the coupon box. Hit "Apply" and then "Register & Continue to Payment". Please promptly drop off or mail your check or cash to 8700 Brecksville Rd., Brecksville, OH 44141, Attention PSR Office. Please add "PSR Registration" in the memo line.

My Products*

St. Basil Parishioner PSR RegistrationRegistration for PSR 2024 - 2025

$80.00 Quantity

St. Basil Non Parishioner PSR RegistrationRegistration for PSR 2024 - 2025

$125.00 Quantity

Enter coupon

Total

$0.00

Should be Empty:

PSR Registration - Fall 2024-2025

Emergency Medical Authorization Form for Student 1

Emergency Medical Authorization Form for Student 2

Emergency Medical Authorization Form for Student 3

Emergency Medical Authorization Form for Student 4

Grant of Consent

REFUSAL of Consent

PHOTO RELEASE