Religious Formation Registration 2012-2013

Christ the King Parish

Pre-Kindergarten through High School

Fees:  1 child:   $40                 2 children:   $55                      3 or more children:   $70

May pay in three installments (installments due on October 15, November 15, and December 15) 

Cost is for total number of students per family in all programs, Elementary - Confirmation

Children need to be four years old by June 1, 2012 in order to be in the Pre-Kindergarten class

All high school students who have already been confirmed are invited to participate in Confirmation classes at no cost.

Name of Parent(s)/Guardian(s) child is living with:

Mother_______________________________________________________________________

Last                                         First                                         Catholic (yes or no)

 _______________________________________________________________________

            Address                                                                                               Zip

Father________________________________________________________________________

            Last                                         First                                         Catholic (yes or no)

________________________________________________________________________

            Address (only if different from mother)                                                     Zip

Phone: _______________________________________________________________________

            Home                          Work (father or mother)          Cell phone (father or mother)

Email Address (to receive reminders/notice of events):_______________________________________

Please check all that apply:

____ Children live with both parents/guardians         ____ Children live with parent & step-parent

____ Parents separated/divorced - shared custody between Mother and Father

____ Children live with Mother only                         ____ Children live with Father only                                                                                                                          

____ Children live with Grandparent(s) only             ____ Other (please explain on back)

Name of Child and Grade entering in the Fall of 2012                                                    

Name________________________________Date of Birth ________________Grade_________

Circle sacraments already received:                                Baptism        Eucharist       Reconciliation        Confirmation

Name__________________________________Date of Birth ________________Grade_______

Circle sacraments already received:                                Baptism        Eucharist       Reconciliation        Confirmation

Name_________________________________Date of Birth _________________Grade_______

Circle sacraments already received:                                Baptism         Eucharist       Reconciliation        Confirmation

                                                                                                                        SEE BACK →

Please list any food allergies, medical conditions, or learning disabilities our formation team should be made aware of:

Child’s Name:_____________________ Grade_____  Allergy/condition__________________________

____________________________________________________________________________________

Child’s Name:_____________________ Grade_____  Allergy/condition__________________________

____________________________________________________________________________________

Child’s Name:_____________________ Grade_____  Allergy/condition__________________________

____________________________________________________________________________________

Consent Form

Please put your initials in front of the statements and sign below for consent.

____  In the event of a medical emergency, if I can not be contacted, I give my consent for emergency medical treatment to be administered to any or all of the children named on this registration form.

____  I give my permission for me and the members of my family to be photographed and for these photos to be displayed at Christ the King and in Religious Formation publicity and promotion. 

Signature of Parent/Legal Guardian: _____________________________   date: _____________

For administrative use only

Paid in Full      $ _______       on date _____________         cash _____      check # _______

Payment Plan  $ _______       on date _____________         cash _____      check # _______

$ _______       on date _____________         cash _____      check # _______

$ _______       on date _____________         cash _____      check # _______