MARY, QUEEN OF PEACE CATHOLIC CHURCH PSR Registration Form
Parish School of Religion | 2026-2027
1. STUDENT INFORMATION
Student Name
*
First Name
Middle Initial
Last Name
Grade *
*
Date of Birth (MM/DD/YYYY) *
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
School Currently Attending *
*
2. PARENT AND FAMILY CONTACT
Father's Name (Last, First, Middle)
First Name
Last Name
Phone
Format: (000) 000-0000.
Mother's Name (Last, First, Middle/Maiden)
First Name
Last Name
Phone
Format: (000) 000-0000.
Home Address *
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Family Email *
*
example@example.com
Special Accommodations or Allergies
3. SACRAMENTAL RECORD
3. SACRAMENTAL RECORD
Rows
DATE (MM/DD/YYYY)
CHURCH NAME AND ADDRESS
Baptism
First Communion
Confirmation
Sacraments Desired This Year
4. EMERGENCY CONTACT
Name *
*
First Name
Last Name
Relationship *
*
Phone *
*
Format: (000) 000-0000.
5. REGISTRATION AND PAYMENT
Registration fee: $25 per student; $50 per family
PAYMENT METHOD
Cash
Check
Teacher Exemption
Check Number
* Required field
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