PSR Registration Form 2025-2026

PSR Student Registration 2025-2026

Parish School of Religion (PSR) at St. Simon Plagge Hall
Family Information
Family Last Name*
Last Name
Parish Name*
Parish where family is registered
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Father's Name*

First NameLast Name
Father's Cell Phone Number*
Please enter a valid phone number.
Mother's Name*

First NameLast Name
Mother's Maiden Name*
Maiden Name
Mother's Cell Phone Number*
Please enter a valid phone number.
Guardian's Name (if applicable):

First NameLast Name
Guardian's Cell Phone Number
Please enter a valid phone number.
Emergency Contact *Someone other than parents*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Relationship to Child*
Relationship to Child
Student Information
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Student Lives With:*
School Attending*
Academic Grade Entering This Fall:*
Registering Student for PSR Grade:*
Please list any of the following: Health issues/dietary restrictions
Please include any additional information that will help us to teach your child in the best way possible. This information will only be shared with your child’s catechist.
Did this child attend PSR at St. Simon last year (2024-2025)?*

YesNo
Click all PSR grades your child has previously completed:*

Grade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7None
At which parish did your child attend PSR?*
Has your child received the Sacrament of Baptism?*

YesNo
Parish where your child was baptized:*
Baptismal Information-Please include the name of church, city and approximate date of your child's baptism:*
Copy of Baptismal Certificate **We must have a copy of this certificate on file to finalize your child's registration**

Cancelof
Has your child received the Sacrament of First Reconciliation?*

YesNo
First Reconciliation information- Please include the following information: Date of Sacrament, Name of Church, City and State where it took place. Please contact your home parish office if you need help with this information.
Date, Church, City and State
Has your child received the Sacrament of First Holy Communion?*

YesNo
First Communion information- Please include the following information: Date of Sacrament, Name of Church, City and State where it took place. Please contact your home parish office if you need help with this information.
Date, Church, City and State
Has your child received the Sacrament of Confirmation?*

YesNo
Sacrament of Confirmation information-Please include the following information: Date of Sacrament, Name of Church, City and State where it took place.
Date, Church, City and State
Register Another Student
Do you want to register another student?*

YesNo
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Student Lives With:*
School Attending*
Academic Grade Entering This Fall:*
Registering Student for PSR Grade:*
Please list any of the following: Health issues/dietary restrictions
Please include any additional information that will help us to teach your child in the best way possible. This information will only be shared with your child’s catechist.
Did this child attend PSR at St. Simon last year (2024-2025)?*

YesNo
Click all PSR grades your child has previously completed:*

Grade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7None
At which parish did your child attend PSR?*
Has your child received the Sacrament of Baptism?*

YesNo
Parish where your child was baptized:*
Baptismal Information-Please include the name of the church, city and approximate date of your child's baptism:*
Copy of Baptismal Certificate **We must have a copy of this certificate on file to finalize your child's registration**

Cancelof
Has your child received the Sacrament of First Reconciliation?*

YesNo
First Reconciliation information- Please include the following information: Date of Sacrament, Name of Church, City and State where it took place. Please contact your home parish office if you need help with this information.
Date, Church, City and State
Has your child received the Sacrament of First Holy Communion?*

YesNo
First Communion information- Please include the following information: Date of Sacrament, Name of Church, City and State where it took place. Please contact your home parish office if you need help with this information.
Date, Church, City and State
Has your child received the Sacrament of Confirmation?*

YesNo
Sacrament of Confirmation information-Please include the following information: Date of Sacrament, Name of Church, City and State where it took place.
Date, Church, City and State
Do you want to register another student?*

YesNo
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Student Lives With:*
School Attending*
Academic Grade Entering This Fall:*
Registering Student for PSR Grade:*
Please list any of the following: Health issues/dietary restrictions
Please include any additional information that will help us to teach your child in the best way possible. This information will only be shared with your child’s catechist.
Did this child attend PSR at St. Simon last year (2024-2025)?*

YesNo
Click all PSR grades your child has previously completed:*

Grade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7None
At which parish did your child attend PSR?*
Has your child received the Sacrament of Baptism?*

YesNo
Parish where your child was baptized:*
Baptismal Information-Please include the name of the church, city and approximate date of your child's baptism:*
Copy of Baptismal Certificate **We must have a copy of this certificate on file to finalize your child's registration**

Cancelof
Has your child received the Sacrament of First Reconciliation?*

YesNo
First Reconciliation information- Please include the following information: Date of Sacrament, Name of Church, City and State where it took place. Please contact your home parish office if you need help with this information.
Date, Church, City and State
Has your child received the Sacrament of First Holy Communion?*

YesNo
First Communion information- Please include the following information: Date of Sacrament, Name of Church, City and State where it took place. Please contact your home parish office if you need help with this information.
Date, Church, City and State
Has your child received the Sacrament of Confirmation?*

YesNo
Sacrament of Confirmation information-Please include the following information: Date of Sacrament, Name of Church, City and State where it took place.
Date, Church, City and State
Do you want to register another student?*

YesNo
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Student Lives With:*
School Attending*
Academic Grade Entering This Fall:*
Registering Student for PSR Grade:*
Please list any of the following: Health issues/dietary restrictions
Please include any additional information that will help us to teach your child in the best way possible. This information will only be shared with your child’s catechist.
Did this child attend PSR at St. Simon last year (2024-2025)?*

YesNo
Click all PSR grades your child has previously completed:*

Grade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7None
At which parish did your child attend PSR?*
Has your child received the Sacrament of Baptism?*

YesNo
Parish where your child was baptized:*
Baptismal Information-Please include the name of the church, city and approximate date of your child's baptism:*
Copy of Baptismal Certificate **We must have a copy of this certificate on file to finalize your child's registration**

Cancelof
Has your child received the Sacrament of First Reconciliation?*

YesNo
First Reconciliation information- Please include the following information: Date of Sacrament, Name of Church, City and State where it took place. Please contact your home parish office if you need help with this information.
Date, Church, City and State
Has your child received the Sacrament of First Holy Communion?*

YesNo
First Communion information- Please include the following information: Date of Sacrament, Name of Church, City and State where it took place. Please contact your home parish office if you need help with this information.
Date, Church, City and State
Has your child received the Sacrament of Confirmation?*

YesNo
Sacrament of Confirmation information-Please include the following information: Date of Sacrament, Name of Church, City and State where it took place.
Date, Church, City and State
Parent's Pledge

As parents/guardians, we accept our role as the primary religious educators of our children. We pledge to support the PSR program and its catachists regarding attendance, participation, discipline and homework assignments. We will do our part to encourage our child's spiritual growth by regularly attending Mass and receiving the sacraments.
Signature*

Clear
Parent/Guardian Name*

First NameLast Name
After submitting this form, you will be directed to fill out an Emergency Medical Form.

Please fill out a form for EACH INDIVIDUAL CHILD attending PSR.
Should be Empty:

PSR Student Registration 2025-2026

Family Information

Student Information

Register Another Student