PSR Registration 2022-2023

Please fill out the following

Parent(s)/Guardian: REQUIRED Please fill out this field. Please enter valid data.

Address: REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number: REQUIRED Please fill out this field. Please enter a phone number.

Phone type: REQUIRED Please fill out this field.

Email: REQUIRED Please fill out this field. Please enter an email address.

Are you a registered parishioner of Our Lady of the Holy Rosary Parish? REQUIRED Please fill out this field.

Child(ren) reside(s) with: REQUIRED Please fill out this field.

If you selected "Other", please explain:

Emergency Contact Name: REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number: REQUIRED Please fill out this field. Please enter a phone number.

Authorization and Permission

I, hereby give permission for my child(ren) listed to participate in the Parish School of Religion (PSR) at Our Lady of the Holy Rosary Parish.

I Agree Please select this field.

Number of children to be enrolled in PSR for the 2021-2022 school year: REQUIRED Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:
Child 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:
Child 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:
Child 8
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:
Child 9
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:
Child 10
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:
Child 11
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:
Child 12
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level for the 2021-2022 school year: REQUIRED Please fill out this field.
- Sacraments Received: Baptism Confirmation Holy Communion
- Is this your child's first year attending PSR at Our Lady of the Holy Rosary? REQUIRED Please fill out this field.
- If you selected "yes", please select from the following:

Please read carefully the statements below. Your electronic signature below confirms your agreement to all statements listed. Contact Mrs. Thérèse Faucheux or Ms. LaSandra Gordon with any questions or concerns at [email protected]

I understand my said child (ren) need to conduct themselves in a Catholic manner at all times while in the classroom with their Parish School of Religion Coordinators and Catechists and while on the grounds of Our Lady of the Holy Rosary Parish. As a family we agree to enforce the respect of church property, the respect of the people leading the Parish School of Religion and my child(ren)'s peers.

Parent or Legal Guardian Electronic Signature

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

By selecting "yes" in the box below, you agree to the following statement - I hereby grant permission to Our Lady of the Holy Rosary Parish to use my child's photo for external publication on the internet at Our Lady of the Holy Rosary Parish's website or in any other official printed and/or electronic publication without further considerations, understanding that my child's full name will not be published on the internet. Please note that this permission is not required to participate in PSR.

Parent or Legal Guardian's assent to the above statement: REQUIRED Please fill out this field.

Payment

Registration is $25 with a family ceiling of $75

If you choose to pay later, you are welcome to do so by cash or check in the office.