Our Lady of Peace Parish Religious Education Program 2012-2013 Registration Form

I. FAMILY INFORMATION Childs Last Name: Parent/Guardian Name(s): Mailing Address: (Street): (City, State, Zip): E-Mail Address: Home Phone: Emergency Contact: (Name) II. PROGRAM CHOICES

Check #: ____________ Date Received: _______ Amount: ____________ Volunteer: __________

Language Spoken at Home: Cell: (Name): Phone:

Grades K-6 meet on Wednesday OR Thursday afternoons from 3:30pm - 4:45pm Grades 7 and 8 only meet on Wednesday Evening from 7:15pm 8:30pm See handbook for details on the Family-Based (FB) Program

A. RETURNING STUDENTS: Grades K-8 (Grade 9 students do not need to register.)

List children who were registered in the Program in 2011-2012 ONLY. If you are enrolling an additional sibling for the first time, add their information in Section III.

CHILDS NAME

GRADE
(In Sept 12)

SCHOOL

CHOICE OF SESSION (Check) WED WED WED WED THUR THUR THUR THUR FB FB FB FB

B. NEW STUDENTS: Grades K-8

A copy of your childs Baptismal Certificate must be submitted unless they were baptized at OLP. Also provide verification of any previous Religious Ed and sacraments received at other parishes.

CHILDS NAME: Boy or Girl: Date of Baptism: Date of First Eucharist: Mothers Maiden Name: Fathers Name: Choice of Session: (Check) CHILDS NAME: Boy or Girl: Date of Baptism: Date of First Eucharist: Choice of Session: (Check) WED Grade in Sept. 2012: WED Grade in Sept. 2012:

Date of Birth: School Attending: Place of Baptism: Place of First Eucharist: Mothers Religion: Fathers Religion: THUR FAMILY-BASED

Date of Birth: School Attending: Place of Baptism: Place of First Eucharist: THUR FAMILY-BASED

III. ALLERGIES/MEDICAL CONDITIONS (All information will remain confidential) A. Does your child have any allergies? (If so, please specify): Childs Name: Allergy: B. Medical condition that we should be aware of? Childs Name: Condition: IV. LEARNING ACCOMMODATIONS Does your child have an IEP/Learning Difference? Childs Name: Accommodations Needed: V. PERMISSION A. I give my children permission to walk home: B. I give permission for my childrens name and photo to appear in local newspapers such as the Independent Press or The Catholic Advocate. C. I give permission for my childrens name and photo to appear on the Parish Website. (www.olpnp.com) No No No Yes Yes Yes No Yes No Yes

No

Yes

VI. TUITION Tuition received on or before June 15, 2012 is at a discounted rate. Please see chart below.
One Child Two Children Three Children Four Children Discount: Received on or before June 15* $130 $250 $300 $325 Regular: June 16 to August 31, 2012 $180 $300 $350 $375 Late Fee: Received after August 31, 2012 $230 $350 $400 $425

GRADES 1 8

KINDERGARTEN $60 Per Child *Discount extended to families new to the program regardless of when registration is received. VII. IMPORTANT INFORMATION AND SIGNATURE I have read the 2012-2013 Religious Education Hand Book and reviewed the policies and procedures with my children. I understand and agree to abide by them.

Parent Signature:

Date:

Number of Children Registering:

Amount Enclosed: $