SMM Religious Education Registration 2024 - 2025
Number of students enrolling in the program.
One
Two
Three
Four
Child 1
Name
*
First Name or Preferred Nickname
Last Name
*
Male
Female
Birth Date
*
-
Month
-
Day
Year
Date
Child's School
*
Child's Incoming Grade (Fall 2023)
*
1
2
3
4
5
6
7
8
Sacraments Received by Child (select all that apply)
Baptism
Reconciliation
Eucharist
Confirmation
Child's Special Needs or Allergies
Update Contact Information
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child(ren) live(s) with:
*
Both Parents
Mother
Father
Legal Guardian
Parent / Guardian 1 Name
*
First Name
Last Name
Parent / Guardian 1 Religion
*
Parent / Guardian 1 Phone
*
-
Area Code
Phone Number
Parent / Guardian 1 Email
*
example@example.com
Parent / Guardian 2 Name
First Name
Last Name
Parent / Guardian 2 Religion
Parent / Guardian 2 Phone
-
Area Code
Phone Number
Parent / Guardian 2 Email
example@example.com
Emergency Contact (if parents cannot be reached)
*
First Name
Last Name
Emergency Contact Relation to Child
*
Emergency Contact Phone
*
-
Area Code
Phone Number
Child 2
Child 2
Name
First Name or Preferred Nickname
Last Name
Male
Female
Birth Date
-
Month
-
Day
Year
Date
Child's School
Child's Incoming Grade (Fall 2023)
1
2
3
4
5
6
7
8
Sacraments Received by Child (select all that apply)
Baptism
Reconciliation
Eucharist
Confirmation
Child's Special Needs or Allergies
Child 3
Child 3
Name
First Name or Preferred Nickname
Last Name
Male
Female
Birth Date
-
Month
-
Day
Year
Date
Child's School
Child's Incoming Grade (Fall 2023)
1
2
3
4
5
6
7
8
Sacraments Received by Child (select all that apply)
Baptism
Reconciliation
Eucharist
Confirmation
Child's Special Needs or Allergies
Child 4
Child 4
Name
First Name or Preferred Nickname
Last Name
Birth Date
-
Month
-
Day
Year
Date
Child's School
Child's Incoming Grade (Fall 2023)
1
2
3
4
5
6
7
8
Sacraments Received by Child (select all that apply)
Baptism
Reconciliation
Eucharist
Confirmation
Child's Special Needs or Allergies
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Registration Fee and Consent
Parish in which family is registered:
*
Regisration Fee
*
SMM Parishioner: $125 per child
Non-SMM Parishioner: $175.00 per child
Home School (fee to be determined)
The registration fee is due the first week of class. Option to pay are as follows:
pay online now using PayPal (3% PayPal fee)
drop off check at SMM parish office
mail check to SMM Religious Ed
6116 Dodge Street, Omaha, NE 68132
Payment method
*
PayPal below
Mail or drop off check (If choosing this form of payment, scroll down to mark consent & then submit.)
Homeschool (fee to be determined)
My Products (ONLY MARK THIS IF PAYING BY PAYPAL)
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( X )
SMM Parishioner - Rel. Ed.
$
125.00
Quantity
0
1
2
3
Non-Parishioner - Rel. Ed.
$
175.00
Quantity
0
1
2
3
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Select the following to consent:
Parental and sibling volunteers are needed to run a successful Religious Education department. All volunteers must be Safe Environment trained (even parking lot monitors!) I agree to be trained or stay up-to-date with my Safe Environment certification.
I give St. Margaret Mary permission to use and/or publish pictures of my child(ren) on the parish website and/or other parish publications.
I authorize a representative of St. Margaret Mary to seek medical treatment for my child(ren) in the event of an emergency in which neither parent nor the adult in whose care the minor has been entrusted can be reached. I authorize any physician or medical center to treat my child(ren) in such a case.
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