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Religious Education Registration

Religious Education Registration Form 2011-2012 Please submit to St. Francis Xavier Parish.
Are you registered as a member of St. Francis Xavier Parish?	YES NO
Parent Information:
FATHER'S FIRST NAME
FATHER'S last name
RELIGION
PLACE OF EMPLOYMENT
FATHER'S ADDRESS
PHONE INFORMATION
HOME
WORK
CELL
FATHER'S EMAIL ADDRESS
MOTHER'S FIRST NAME
Mother's Maiden name
MOTHER'S LAST NAME
RELIGION
PLACE OF EMPLOYMENT
SAME ADDRESS
Mother's Address if not the same
PHONE INFORMATION
HOME
WORK
CELL
MOTHER'S EMAIL ADDRESS
Marital Status	Married Separated Divorced Single Parent
Child/Children reside (s) with:	Both Mother Father
Address if children do not reside with both parents
CHILD 1 BAPTISMAL NAME
GRADE
GENDER	Female Male
SCHOOL ATTENDING
Check if your child has received the Sacraments of:	Baptism Penance Eucharist
If yes, parish of Baptism
Needing Sacraments	Yes No
If Yes	Reconcilation First Eucharist Confiramtion
CHILD 2 BAPTISMAL NAME
GENDER	Female Male
Grade
School Attending
Check if your child has received the Sacraments of:	Baptism Penance Eucharist
If yes, Parish of Baptism
Needing Sacraments	Yes No
If Yes	Reconcilation First Eucharist Confirmation
CHILD 3 BAPTISMAL NAME
GENDER	Female Male
GRADE
School Attending
Check if your child has received the Sacraments of:	Baptism Penance Eucharist
If yes, Parish of Baptism
Needing Sacraments	Yes No
If yes	Reconcilation First Eucharist Confirmation
CHILD 4 BAPTISMAL NAME
GENDER	Female Male
Grade
School Attending
Check if your child has received the Sacraments of:	Baptism Penance Eucharist
If yes, parish of Baptism
Needng Sacraments	Yes No
If Yes	Reconcilation First Eucharist Confirmation
Child 5 Baptismal Name
Gender	Female Male
Grade
School Attending
Check if your child has received the Sacraments of:	Baptism Penance Eucharist
If yes, Parish of Baptism
Needing Sacraments	Yes No
If Yes	Reconcilaton Eucharistic Minister Confirmation
In the event of serious accident Illness concerning my child, I understand that the Religious Education staff will try to contact me using the information supplied. If the RE staff cannot reach me, I hereby authorize the RE staff to contact the doctor indicated and follow his/her instructions.
DOCTOR'S NAME
CLINIC'S NAME
If the doctor cannot be reached, I authorize the RE staff to take whatever procedures they deem necessary for the health, security, and comfort of my child
Signature of Parent/Guardian
Date
People Authorized to pick up your child in case of an emergency:
NAME
RELATIONSHIP
Evening Phone#
Each family is expected to VOLUNTEER in one of these areas:
CATECHIST FOR GRADE 1-10:	yes No
GRADE PREFERENCE:
ASSISTANT TO THE CATECHIST FOR GRADE:	1 2 3 4 5 6 7 8 9 10
SUBSITUE CATECHIST FOR GRADES:
OFFICE/HALL/PARKING LOT MONITOR DURING CLASS TIME:	Sept.-Nov. Dec.-Feb. Mar. - May
DAYTIME OFFICE HELP:	yes No
SPEAKERS OR PRESENTERS ON SPIRITUAL TOPICS (IE: PRAYER, DRUG AWARNESS, LIVING A BALANCED LIFE, PARISH MINISTRY OPPORTUNITIES):	yes No
TOPIC:
Religious Education Program Fee: $90.00 for one child, $180.00 for two children, three or more children $200.00. Monthly, Quarterly payments can be made. Balance due by May 01, 2012
Please pay the minimum of $30.00 per child with this registration form.
PAID BY	Check Auto payment
PAYMENT PLAN CHOSEN:	Payment in full Monthly Quarterly $30.00 per child minimum.
TOTAL PAID
BALANCE
BALANCE TO BE PAID:	Monthly quarterly
If paying by check - Make checks payable to: St. Francs Xavier Parish Mail to: St. Francis Xavier Parish Religious Education PO Box 150 Sartell, MN 56377
No child is turned away because of lack of funds. please note below if circumstances are such that you are unable to pay the fee.
Special Needs:
Special Needs: We strive to make every effort possible to meet the needs of your child. Does your child have any special needs due to a learning disability, physical disability, reading difficulty, hearing impairment, emotional problem, or any other reason?
NAME OF CHILD
Special Needs:
Describe any allergy, chronic illness, or other conditions:
Does this child take any medications?	No Yes
If yes, please describe
NAME OF CHILD:
Special Need:
Describe any allergy, chronic illness, or other conditions:
Does this child take any medications?	No Yes
If yes, please describe
Additional Information: