St. Helen Parish School of Religion 2024-2025

St. Helen Parish School of Religion

Registration Form 2024-2025
Child 1 Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
School*
Grade (in the fall)*
Child 2 Name

First NameLast Name
Date of Birth

MonthDayYear
Date
School
Grade (in the fall)
Child 3 Name

First NameLast Name
Date of Birth

MonthDayYear
Date
School
Grade (in the fall)
Child 4 Name

First NameLast Name
Date of Birth

MonthDayYear
Date
School
Grade (in the fall)
Has your child/children been baptized?*
Please indicate the Church of Baptism for each child. If your child was not baptized at St. Helen please provide us with a copy of baptismal certificate. (if you previously submitted baptismal certificates you don't have to do this again)*
Are you a registered member of St. Helen Parish?*
If you are NOT a registered member of St. Helen Parish please indcate which parish you belong to
name of parish
Parent/Guardian Name (1)*

First NameLast Name
Parent/Guardian Name (2)*

First NameLast Name
Parent 1 Email*
example@example.com
Parent 1 Phone Number*
Please enter a valid phone number.
Parent 2 Email
example@example.com
Parent 2 Phone Number*
Please enter a valid phone number.
Address*

Mailing Address

CityState / Province

Postal / Zip Code
Emergency Contact Name (other than a parent)*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Preferred Hospital*
Hospital Phone Number*
Please enter a valid phone number.
Name of Physician/Pediatrician*

First NameLast Name
Physician/Pediatrican Phone Number*
Please enter a valid phone number.
Any Allergies or Medical Conditions?*

YesNo
Please give details and let us know if your child has any learning difficulties (Confidential)
Do you want to add something about your child?
Payment Information

Registration fee is $50 per child. If more than 3 children, the 4th child is free. Add $50 if you have a child in 2nd grade for First Communion. Add $50 if you have an 8th grader receiving Confirmation. You can pay through on-line giving or with a check payable to St Helen. If you choose on-line giving, after you submit this form you will be directed to the online giving website. If you choose to pay by cash or check please have payment in by Sept 1st 2024. If you have a child/children receiving a Sacrament you can pay with ONE check.
I intend to pay by*
I, undersigned, agree with the following statements:*

I am the parent/guardian of the child/children indicated above.If emergency medical care is needed and I am unavailable, I authorize the supervising teacher to seek medical treatment for my child.I am giving my permission to take my child's pictures and post them on the church website or inside the school/church facility.I agree to submit payment by Sep 1st 2024
Date*

MonthDayYear
Date
Signature*

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