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PREP Registration Form

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2018-2019 PREP REGISTRATION FORM
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- Number of Students being registered REQUIRED Please fill out this field.
  
  Student 1
  
  Student Name REQUIRED
  Please provice the student's First and Last Name
  Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED
  ex: 02/05/2010
  Please fill out this field. Please enter a date.
  
  PREP Grade Level Please enter valid data.
  
  Public School your child attends Please enter valid data.
  
  School Grade Please enter valid data.
  
  PLEASE CHOOSE ONE: This student is a RETURNING STUDENT to the CCD Program and Baptismal Information is on file This student is a NEW STUDENT to the CCD program. Please provide the EXACT BAPTISMAL DATE. IF your child was not baptized at St. Bernadete, please provide a copy of the Baptimal Certificate.
  
  IF STUDENT IS ENTERING OUR PREP PROGRAM AS A NEW STUDENT, ABOVE GRADE 1 - PLEASE PROVIDE WHICH PARISH RELIGIOUS EDUCATION PROGRAM WAS PREVIOUSLY ATTENDED AND WHICH GRADE LEVEL WAS COMPLETED.
  
  PLEASE PROVIDE EXACT DATE AND PARISH OF BAPTISM for NEW STUDENTS Please enter valid data.
  
  Check all other Sacraments this Student has received Penance First Communion Confirmation
  
  Student 2
  
  Student Name REQUIRED
  Please provice the student's First and Last Name
  Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED
  ex: 02/05/2010
  Please fill out this field. Please enter a date.
  
  PREP Grade Level Please enter valid data.
  
  Public School your child attends Please enter valid data.
  
  School Grade Please enter valid data.
  
  PLEASE CHOOSE ONE: This student is a RETURNING STUDENT to the CCD Program and Baptismal Information is on file This student is a NEW STUDENT to the CCD program. Please provide the EXACT BAPTISMAL DATE. IF your child was not baptized at St. Bernadete, please provide a copy of the Baptimal Certificate.
  
  IF STUDENT IS ENTERING OUR PREP PROGRAM AS A NEW STUDENT, ABOVE GRADE 1 - PLEASE PROVIDE WHICH PARISH RELIGIOUS EDUCATION PROGRAM WAS PREVIOUSLY ATTENDED AND WHICH GRADE LEVEL WAS COMPLETED.
  
  PLEASE PROVIDE EXACT DATE AND PARISH OF BAPTISM for NEW STUDENTS Please enter valid data.
  
  Check all other Sacraments this Student has received Penance First Communion Confirmation
  
  Student 3
  
  Student Name REQUIRED
  Please provice the student's First and Last Name
  Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED
  ex: 02/05/2010
  Please fill out this field. Please enter a date.
  
  PREP Grade Level Please enter valid data.
  
  Public School your child attends Please enter valid data.
  
  School Grade Please enter valid data.
  
  PLEASE CHOOSE ONE: This student is a RETURNING STUDENT to the CCD Program and Baptismal Information is on file This student is a NEW STUDENT to the CCD program. Please provide the EXACT BAPTISMAL DATE. IF your child was not baptized at St. Bernadete, please provide a copy of the Baptimal Certificate.
  
  IF STUDENT IS ENTERING OUR PREP PROGRAM AS A NEW STUDENT, ABOVE GRADE 1 - PLEASE PROVIDE WHICH PARISH RELIGIOUS EDUCATION PROGRAM WAS PREVIOUSLY ATTENDED AND WHICH GRADE LEVEL WAS COMPLETED.
  
  PLEASE PROVIDE EXACT DATE AND PARISH OF BAPTISM for NEW STUDENTS Please enter valid data.
  
  Check all other Sacraments this Student has received Penance First Communion Confirmation
  
  Student 4
  
  Student Name REQUIRED
  Please provice the student's First and Last Name
  Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED
  ex: 02/05/2010
  Please fill out this field. Please enter a date.
  
  PREP Grade Level Please enter valid data.
  
  Public School your child attends Please enter valid data.
  
  School Grade Please enter valid data.
  
  PLEASE CHOOSE ONE: This student is a RETURNING STUDENT to the CCD Program and Baptismal Information is on file This student is a NEW STUDENT to the CCD program. Please provide the EXACT BAPTISMAL DATE. IF your child was not baptized at St. Bernadete, please provide a copy of the Baptimal Certificate.
  
  IF STUDENT IS ENTERING OUR PREP PROGRAM AS A NEW STUDENT, ABOVE GRADE 1 - PLEASE PROVIDE WHICH PARISH RELIGIOUS EDUCATION PROGRAM WAS PREVIOUSLY ATTENDED AND WHICH GRADE LEVEL WAS COMPLETED.
  
  PLEASE PROVIDE EXACT DATE AND PARISH OF BAPTISM for NEW STUDENTS Please enter valid data.
  
  Check all other Sacraments this Student has received Penance First Communion Confirmation
  
  Student 5
  
  Student Name REQUIRED
  Please provice the student's First and Last Name
  Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED
  ex: 02/05/2010
  Please fill out this field. Please enter a date.
  
  PREP Grade Level Please enter valid data.
  
  Public School your child attends Please enter valid data.
  
  School Grade Please enter valid data.
  
  PLEASE CHOOSE ONE: This student is a RETURNING STUDENT to the CCD Program and Baptismal Information is on file This student is a NEW STUDENT to the CCD program. Please provide the EXACT BAPTISMAL DATE. IF your child was not baptized at St. Bernadete, please provide a copy of the Baptimal Certificate.
  
  IF STUDENT IS ENTERING OUR PREP PROGRAM AS A NEW STUDENT, ABOVE GRADE 1 - PLEASE PROVIDE WHICH PARISH RELIGIOUS EDUCATION PROGRAM WAS PREVIOUSLY ATTENDED AND WHICH GRADE LEVEL WAS COMPLETED.
  
  PLEASE PROVIDE EXACT DATE AND PARISH OF BAPTISM for NEW STUDENTS Please enter valid data.
  
  Check all other Sacraments this Student has received Penance First Communion Confirmation
- FAMILY INFORMATION
  
  We are REGISTERED MEMBERS of St. Bernadette of Lourdes Parish REQUIRED Yes No - I understand that our family will have to register at St. Bernadette Parish or get a letter of permission my our Parish to attend CCD at St. Bernadette. Please fill out this field.
  
  Please choose one REQUIRED We are a NEW family to the CCD/PREP Program. Please complete the "Family Information Section" We are a RETURNING family and our "Family Information" HAS NOT changed from last year. Please skip this section and move to the Medical and Educational Information We are a RETURNING FAMILY and our "Family Information" HAS changed. Please update the Family Information Section. Please fill out this field.
  
  Family Name Please enter valid data.
  
  Home Phone Number Please enter a phone number.
  
  Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Father's Name Please enter valid data.
  
  Cell Phone Please enter a phone number.
  
  Email Please enter an email address.
  
  Mother's Name Please enter valid data.
  
  Cell Phone Please enter a phone number.
  
  Email Please enter an email address.
  
  Custody: Are there any legal/custody issues? (If yes, please provide a copy of the most current court order.) Yes No
  
  *Name of person responsible for Religious Education if not a Parent/Guardian.
- MEDICAL AND EDUCATIONAL INFORMATION
  
  Emergency Contact REQUIRED Please fill out this field.
  
  Cell Phone Please enter a phone number.
  
  Home Phone Please enter a phone number.
  
  Relationship to Family Please enter valid data.
  
  Permission is given for my child/ren, in my absence, to recieve emergency medical care for injuries or situtions that may occur during Religious Education Program hours and/or activites at St. Berndaette Parish YES NO
  
  Medical/Learning Data
- Our program runs with the generosity of our volunteers. Please choose any are you would be able to volunteer. All regular vounteers are required to obtain clearances/background checks and attend the required Safe Enviorment classes and trainings Teacher Aide Substitute Other
- Our family agrees to read and abide by the St. Bernadette Parish Religious Education Program Handbook. Agree
- The Handbook can be found HERE!
- Permission is given for my child's picture and/or name to appear on the St. Bernadette website, bulletin boards, social media, and newspaper articles in relation to events that happen in the parish. YES NO
- There is a fee required for all students who attend Religious Education Classes at St. Bernadette’s.
  A minimum of $25 per child is required at the time of registration, which will be applied to your balance.
  If not paying in full at the time of registration, please indicate your weekly or monthly payment plan.
  All CCD Tuition must be paid in full by
  December 31, 2018
  
  Early Registration Discount Ended August 15th
  
  REGULAR CCD/PREP RATES 2018-2019
  1 Child - $225 (7.50 a week)
  2 Children - $420 ($14 a week)
  3 or more Children - $520 ($17.34 a week)
  
  All CCD families are asked to fulfill their obligation to attend Sunday Mass.
  We kindly ask all families to contribute at least $20.00 to the weekly Sunday Collections .
- We agree to pay the required CCD/PREP fees, in full, as indicated (Check all that apply):
  Check all that apply
  One payment Payment plan, due, in full, by December 31, 2018 Scrip Payments
- Payment Plan:
- By submitting this form, I/We attest that all the information provided is correct. I/We understand that this information will be used by the Religious Education Office and to upate the St. Bernadette Parish database. I/We agree that all CCD/PREP fees will be paid as indicated above.
- I Agree Please select this field.
- Date Submitted REQUIRED Please fill out this field. Please enter a date.
Submit