E.C./P.S.R. Registration Form 2018-2019

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Early Childhood (E.C.) takes place DURING the 9:15am mass. Parish School of Religion (P.S.R) is from 10:20-11:20. Fees for E.C. and P.S.R. are: $40 for the first child, $30 each additional PSR child, $20 each additional EC child. Payment options are listed in the last question on this form. Questions? Contact Bridget Bockey at bbockey@delphosstjohns.org or 419-233-1600

Father's/Guardian's First Name *

Father's/Guardian's Last Name *

Father/Guardian's Religion *

Mother's/Guardian's First Name *

Mother's/Guardian's Last Name *

Mother's/Guardian's Religion *

Mother's Maiden Name

Street Address *

City/State/Zip *

Home Phone # *

Primary Phone #

Email address *

Alternate Email Address

Child(ren) lives with *

Both Parents

Mother Only

Father Only

Guardian

Mother & Stepfather

Father & Stepmother

Are you a registered parishoner at Delphos, St. John? *

Yes

Other:

School that child(ren) attend? (Information needed for securing release day/s for sacrament preparation) *

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