St. Peter Catholic Church
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2019-2020 Religious Education Registration Form
Family Information
*
Indicates required field
Last Name
*
Home Phone Number
*
Are you registered in the parish?
*
Yes
No
Address
*
City
*
State
*
Zipcode
*
Father/Guardian
*
Father's Cell Phone
*
Father's Email Address
*
Mother/Guardian
*
I / We can help:
*
Please Select One
Teach/Co-Teach
Aide
Mother's Cell Phone
*
Mother's Email Address
*
Student Information - Child 1
Child's Name: First, Middle, Last
*
Entering Grade
*
Gender
*
Male
Female
Date of Birth
*
City & State of Birth
*
Indicate Sacraments already received:
*
Baptism
Reconciliation
Communion
Allergies, Special Needs or Medical Conditions:
*
Student Information - Child 2
Child's Name: First, Middle, Last
*
Entering Grade
*
Gender
*
Male
Female
Date of Birth
*
City & State of Birth
*
Indicate Sacraments already received:
*
Baptism
Reconciliation
Communion
Allergies, Special Needs or Medical Conditions:
*
Student Information - Child 3
Child's Name: First, Middle, Last
*
Entering Grade
*
Gender
*
Male
Female
Date of Birth
*
City & State of Birth
*
Indicate Sacraments already received:
*
Baptism
Reconciliation
Communion
Allergies, Special Needs or Medical Conditions:
*
If you are registering more than 3 children, complete and submit this form.
Please then visit the Religious Education Program page and select the option to register additional children.
Emergency Information
If my child becomes ill or is injured while attending Religious Education classes, please call:
Name
*
Relationship to Student
*
Phone Number
*
Name
*
Relationship to Student
*
Phone Number
*
I authorize the staff of Saint Peter to seek emergency medical care for my child as deemed appropriate.
Our Doctor preference is:
*
Phone Number
*
Our Dentist preference is:
*
Phone Number
*
Our Hospital preference is:
*
Phone Number
*
Please enter your full name to confirm your consent
*
Date
*
Photography & Video Consent
Parents/guardians of participants are advised that photograph or videotape of participants may be used in publications,
websites or other materials produced from time to time by Saint Peter Church, the Offices of Religious Education and Youth
Ministry or the Diocese of Harrisburg. Parents/guardians who do not wish their children be filmed or photographed should
notify the Office in writing. Please note that the Office has no control over the use of photographs or film taken by media that
may be covering the event in which your children participate.
Please Select One
*
Yes, I consent
No, I do not consent
Please enter your full name to confirm your consent
*
Date
*
Tuition Rates for Religious Education
Paying tuition ON or BEFORE 8/31/2016 (Please select all that apply)
*
First Child $55.00
Second Child $50.00
Third Child $45.00
Fourth Child $40.00
Fifth Child $0.00 (Fee Waived)
Sacramental Fees – Students in Grades 2, 7 & 8 have a sacramental preparation fee of $25.00 per child.
How many children are registering in grades: 2, 7, 8?
*
No Children
1 Child
2 Children
3 Children
4 Children
Submit Form
Home
From The Pastor
Online Masses
Parish Info
Welcome
Mass & Reconciliation
Sacramental Information
Register With Parish
Parish Team
Photo Gallery
Education
RCIA
Guardian Angel
Religious Education
>
RE Registration
Vacation Bible School
Catholic Education
SCRIP
Ministry
YOUTH MINISTRY
Ministry Schedule
CAMPUS MINISTRY
Parish Ministries
News
Parishioner News
DIOCESAN NEWS
Weekly Bulletin
Weekly Calendar
Monthly Look
Upcoming Events
St Peter Columbarium
Stewardship
Online Giving
Opportunities