Religious Education Registration Form
Welcome to St. Mary Catholic Church PSR! Classes will begin on Sunday, September 13. Use this form to register you child. If you are registering more than one child, please submit additional forms.
Email address *
Contact us
If you have questions or if you prefer to register by phone, please call Elissa Chausse, Coordinator of Religious Education, at 573-883-6130.
Family name *
Primary address *
Father's name *
Father's phone number *
Father's email *
Mother's name *
Mother's phone number *
Mother's email *
Child's name (first, middle, last) *
Date of birth *
MM
/
DD
/
YYYY
Grade in school *
Parish child was Baptized *
Date child was baptized *
Has the child had his/her First Communion? *
Allergies or health concerns?
Special learning needs?
Child lives with *
If necessary, provide the second address
Emergency contact name *
Emergency contact phone *
Phone number to be used for Remind updates *
Do you give permission for your child's name and image to be included in publicity releases about parish events in the bulletin, parish website, and local or diocesan newspaper? *
Payment
$25.00 per child to cover the cost of the textbook. Due October 4. Send payment marked “PSR fee” to St. Mary Catholic Church 101 S. Meyer, Valmeyer, IL 62295 or drop your payment in the collection basket using a separate envelope marked appropriately for PSR.
The Future of our Program
Please help us spread the word about our PSR program. If you know anyone who is interested in sending their child to our parish for classes, please let them know we are more than happy to speak to them about the program and help get them registered. They can call Elissa at 573-883-6130. Thank you!
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms