Beruflich Dokumente
Kultur Dokumente
Michael Parish School of Religion (PSR) Family Registration Information form 2015-2016
preferred family name: _______________________________
Parent/Guardian information
last name
first name
_________________________
_____________________
____________________________________
______________
mother
_________________________
mother maiden name ______________________
_____________________
____________________________________
______________
father
religion
parish: ____________________________
1 ______________________ home
2 ______________________ mom cell
Student Name:
last name: _______________ first name: ____________ nickname: ____________
middle: ______________
dob: ____________
student cell (if applicable): ____________________ student email (if applicable): _____________________________ grade: __________
Sacraments:
Baptism
______________ ____________________
baptismal certificate on file at St. Michael? _______________
received:
date
church name/location
1st Reconciliation
______________ ____________________
name of school : __________________
Eucharist
Confirmation
date
church name/location
date
church name/location
date
church name/location
______________
____________________
______________ ____________________
catholic? ______________________
# of years attended PSR at St. Michael: __________________
Student Name:
last name: ______________________________ first name: _____________________ middle: ______________
dob: ____________
student cell (if applicable): ____________________ student email (if applicable): _____________________________ grade: __________
Sacraments:
Baptism
______________ ____________________
baptismal certificate on file at St. Michael? _______________
received:
date
church name/location
1st Reconciliation
______________ ____________________
name of school : __________________
Eucharist
Confirmation
date
church name/location
date
church name/location
date
church name/location
______________
____________________
______________ ____________________
catholic? ______________________
# of years attended PSR at St. Michael: __________________
Student Name:
last name: ______________________________ first name: _____________________ middle: ______________
dob: ____________
student cell (if applicable): ____________________ student email (if applicable): _____________________________ grade: __________
Sacraments:
Baptism
______________ ____________________
baptismal certificate on file at St. Michael? _______________
received:
date
church name/location
1st Reconciliation
______________ ____________________
name of school : __________________
Eucharist
Confirmation
date
church name/location
date
church name/location
date
church name/location
______________
____________________
______________ ____________________
catholic? ______________________
# of years attended PSR at St. Michael: __________________
name ___________________________________
email ______________________________
cell/work ____________________________
Sunday or evening?__________
Sunday or evening?__________
Sunday or evening?__________
WE THANK YOU FOR YOUR SERVICE TO OUR YOUTH AND OUR PARISH!
Media Authorization
I hereby authorize St. Michael Catholic Church, Girard, KS, the Catholic Diocese of Wichita, and its agents to utilize photographic and/or video
images of me or my child. In giving my consent, I hereby indemnify and hold harmless St. Michaels Church, Girard, the Catholic Diocese of
Wichita and its agents from any and all responsibility or liability. I understand that I will receive no compensation, should any photograph and/or
video of me or my child be used.
individuals name(s):
_________________________________________________________
date _______________
__________________________________________________
Fee Information
one child: $10.00
**please make your check out to St. Michael PSR and return along with this enrollment form.
_______________
date:
_______________
cash
check