PSR Registration Form 2025/2026
Our PSR classes are intended for parish children attending public school whose families wish them to be formed in the Catholic faith. We offer faith formation for children in Pre-School (age 4) through 8th grade. Classes are held on Sunday mornings during the academic year September through April. Classes will begin Sunday, September 7, 2025 from 9:45 am -10:45 am in the St. Patrick School building. Our fees for parish families of St. Patrick Parish, University Parish Newman Center and Immaculate Conception are $35 for one child or $60 for two or more children. You can write a check to St. Patrick Church and drop it at the parish office. You may also pay the fees through myEoffering on the parish website. Make certain you choose PSR Registration Fees under the account tab.
Student's Full Name
*
First Name
Middle Name
Last Name
Suffix
Student's Date of Birth
*
-
Month
-
Day
Year
Date
PSR Grade
*
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Father's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Mother's Name
First Name
Last Name
Maiden Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Family Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number in Case of Emergency
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Emergency Contact (In case a parent cannot be reached)
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Home Parish
*
Immaculate Conception
University Parish Newman Center
St. Patrick Parish
Other
Please list the names of persons that the student is permitted to be released to in addition to parents/legal guardians: (parish must be notified in writing if this changes)
Name
Relationship to the Student
Name
Relationship to the Student
Name
Relationship to the Student
Name
Relationship to the Student
In the event reasonable attempts to contact me have been unsuccessful:
*
I GIVE my consent for the transfer of my child to any hospital that is accessible and the administrationof any treatment deemed necessary by the attending physician.This authorization does not cover major surgery unless in the medical opinion of two other licensed physiciansor dentists such surgery is absolutely necessary and these opinions are obtained prior to the performance of surgery
I DO NOT GIVE my consent to emergency medical treatment. Describe desired action to be taken:
Medical or Special Concerns
Please indicate any information that would be helpful in the case of an accident or an emergency. Include anyallergies, physical impairments and/or medication your child takes on a regular basis. Also use this area to giveany information of which you would like your child’s instructor to be aware. Attach an extra page if necessary.
Permission For Name And/Or Image Use
Please Indicate Below:
*
I GIVE permission for my child's name or image to be included in publicity releases about parishevents in the bulletin, parish website, parish Facebook page, and local or diocesan newspaper.
DO NOT use my child’s name or image in public media.
In completing and submitting this form I am requesting St. Patrick Parish to provide religious education for my child. I have provided the information above and I understand that any changes must be submitted in writing to the parish office.
*
Date
*
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: