St. Lucie Catholic Church Religious Education Department

St. Lucie Catholic Church Religious Education Department

St. Lucie Catholic Church
Religious Education Department
RE-REGISTRATION
FOR CURRENT STUDENTS ONLY
For Year:_______-________
STUDENT NAME_______________________________________________________________________
FIRST AND LAST NAMES / NOMBRE Y APELLIDOS
FATHER’S NAME____________________________ MOTHER’S NAME_______________________________
Please indicate if there are any changes in your:
Por favor indicar si hay algún cambio en:
ADDRESS:___________________________________________ HOME PHONE________________________
Dirección
Teléfono de casa
MOM’S CELL:_______________________________
DAD’S CELL:__________________________________
Celular de mama
cellular de papa
Sacraments this child has received (check all that apply and furnish documentation if not on file)
¿Sacramentos recibidos? (Indicar los que son aplicables y proveer documentos si es necesario)
BAPTISM_________ FIRST RECONCILIATION_________ FIRST COMMUNION__________CONFIRMATION___________
BAUTIZO
RECONCILIACION/CONFESION
PRIMERA COMUNION
CONFIRMACION
SCHOOL GRADE ENTERING IN FALL __________ SCHOOL ATTENDING______________________________
Grado escolar empezando en el otoño
Escuela a la que asiste
What day of the week did your child attend last year?
SUN._______MON________TUE________ WED________
Que día de la semana asistió su hijo/a a la catequesis el año pasado
Domingo
Lunes
Martes
Miércoles
Name of class child attended last year: Circle one
Nombre del niño asistió a clase el año pasado
Kindergarten
Comm Prep I
(Ages 9-12)
Comm Prep I
Comm Prep II
Comm Prep II
Edge 7
Level 3
Edge 8
Level 4
Level 5
Sacramental Prep For Children
Level 6
Sac Prep Teens
(Ages 9-12)
List any concerns regarding this child’s health, behaviors or special needs___________________________
Nombre si el niño/a tiene alguna dificultad de aprendizaje, problema de salud o alguna necesidad especial
(Please turn over)
FOR OFFICE USE ONLY
Session and Grade Desired______________________________________________________
Registration Fee: $75.00
Each additional child: $25.00
Sacrament supply fee: $30.00
(The Sacramental supply fee applies to those making First Communion or Confirmation this year)
Method of Payment: Check one
Cash
Amount Owed: $_______________
Check #:_________
Amount Received: $____________
Credit Card
Amount Due: $________________
Bill Later (Payment Plan filled out)
Date:_________________________
St. Lucie Catholic Church
Religious Education Department
RE-REGISTRATION
FOR CURRENT STUDENTS ONLY
EMERGENCY INFORMATION
Información de Emergencia
Emergency Contact (Other than Parent)__________________________________________ Phone #_________________________
Contacto en caso de Emergencia (salvo padres)
Teléfono
If emergency treatment is required and the parent/s authorized emergency contact cannot be reached your signature in the
space provided below empowers the church authorities to exercise their own judgment in calling 911, the above-named
physician or transporting the child to a hospital emergency room if necessary. Your signature is not sufficient; however, for the
release of confidential information protected by federal law.
En caso que se requira atención médica de urgencia y no podamos comunicarnos con los padres o el contacto de emergencia, su firma debajo, autoriza a los
administradores de la iglesia a llamar al 911, a los médicos indicados y a transportar, si es necesario, sus hijos al hospital. Su firma no es suficiente sin
embargopara divulgar información confidencial protegida por ley federal.
____________________________________
Parent Signature/ Firma de la Madre
__________
Date/Fecha
__________________________________
Parent Signature/ Firma del padre
Are you a registered member of St. Lucie? _______ Registration#________
¿Son miembros inscritos en la iglesia de St. Lucie?
Número de inscripción
If no, are you registered in another Catholic Church ________?
Si no, ¿están registrados en otra iglesia?
____________
Date/Fecha