PSR Registration 2020-2021 (Please complete 1 form per PSR student)

Immaculate Conception –St. John the Apostle

P.S.R. Registration

2020-2021

Student Name  (first and last)

____________________________________________________________

Grade __________

Address _____________________________________________________________________

         _____________________________________________________________________

Student’s Date of Birth

__________________________________________________________


Student’s Home Parish

__________________________________________________________

 

Parent(s):  (first & last names)                                          Catholic? Please circle Y(es) or N(o).

 

Father ________________________________________                                Y           N

 

Mother _______________________________________                                  Y          N

 

Date and Church of  Student’s Baptism ______________________________


                                                                    _____________________________


                                                                    ______________________________


Has student made Sacrament of Reconciliation? __________

 

Has student made Sacrament of First Eucharist? __________

Date________________________

 

Has student been confirmed? __________  If yes, where and when?

                                                                __________________________________________

                                                                     __________________________________________

                                                               __________________________________________

 

Comments (may include medical issues or any other concerns you wish to address):

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

 

Contacts:

   Home or cell

   _________________________________________________________________

 

   Emergency Contact

   ___________________________________________________________

 

   Parent(s) E-Mail Address(es)

   ___________________________________________________.

 

Registration Fee Paid__________

 

Office Use Only:  Date Servant Keeper Updated________________________

 

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