PSR Registration Form 26-27

St. Francis of Assisi
Parish School of Religion
203 E Main St PO Box 730
Teutopolis, IL 62467
217-961-6477
PSR Registration Form

School Year 2026-2027
Parent/Guardians' Names:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Format: (000) 000-0000.
Cell:
Format: (000) 000-0000.
Email:
example@example.com
Student(s) live with (Circle one)

Both ParentsMotherFatherOther
Are you registered members of St. Francis of Assisi Parish?

YesNo
If No, what parish or Church are you registered with?
City

Rows	Child(ren) Names: Grade 1-12th	Grade:	Church Baptized	School Child Attends
1
2
3
4
5

I want my child/children to participate in the Religion Program. (The children will receive a text to use and other materials.) Bills for these materials are $40 per child or a $100 maximum per family yearly to be paid to St. Francis Church, PO Box 730, Teutopolis, IL 62467.I want my child/children to be supervised from 7:15 am - 7:50 am by the St. Francis Parish Religious Education Program volunteers.I want my child/children to receive the sacraments with St. Francis of Assisi Parish. If your child was not baptized in St. Francis of Assisi, we need a copy of the child's baptismal certificate or record.
Personal Safety Training
The Office of Child and Youth Protection in Washington, DC requires safe environment training for children in religion education programs. We will be using a video and an instructional lesson provided by the diocese during a regularly scheduled religion class to communicate the tips on keeping our children safe. This is required training each year for the children. Each class has a scheduled day to view a video and be taught a lesson. Parents are welcome to view the video and lesson materials. Please read the following questions carefully and check those that apply.

I would like to view the video and lesson materials with my child(ren).I give my permission for my child(ren) to participate in the Personal Safety Training Session.I do not give my permission for these child(ren) to participate in the Personal Safety Training Session.
The following child(ren) will not participate:
Child 1:
Child 2:
Child 3:
(Parent/Guardian Signature)
(Date)

MonthDayYear
Date
*Has your child been baptized? If your child is 7 or older and has not been baptized, they will need to participate in an OCIA class adapted for children so that they can be baptized and participate in the sacraments.

PSR Registration Form

Personal Safety Training

Medical Information:

Emergency Contact:

Media Consent:

Volunteer to Help: