St. Boniface Church PSR
PSR 2018-2019 Registration Form
To complete the registration process, please submit your $45 registration fee per student to the PSR Coordinator or the parish office no later than July 31, 2018. Fees increase to $55 after that date. Please contact the PSR Coordinator should you have any concerns regarding the registration fee.
Student's GIVEN Name *
Your answer
Gender *
2018-2019 Grade *
Birthdate *
MM
/
DD
/
YYYY
Birth Place (city, state) *
Your answer
St. Boniface Parishioner? *
If not a St. Boniface Parishioner, parish name:
Your answer
Student Baptism Date *
Your answer
Student Baptism Church, City, State *
Your answer
Student First Communion Date
Your answer
Student First Communion Church, City, State
Your answer
Child Lives with: *
Parent/Guardian Name *
Your answer
Parent/Guardian Relationship to Student *
Parent/Guardian Religion
Parent/Guardian Address *
Your answer
Parent/Guardian Phone *
Your answer
Parent/Guardian Email Address *
Your answer
Parent/Guardian Name
Your answer
Parent/Guardian Relationship to Student
Parent/Guardian Religion
Parent/Guardian Address (if different from above)
Your answer
Parent/Guardian Phone
Your answer
Parent/Guardian Email Address
Your answer
Please explain any special needs/circumstances concerning your child/family:
Your answer
Emergency Contact 1 (name, relationship, phone) *
Your answer
Emergency Contact 2 (name, relationship, phone) *
Your answer
A successful PSR program needs parent involvement. Please indicate where you would be willing to volunteer. *
Photograph Release--We need your permission to use photos of your child on the parish website, in parish publications, and in parish print/digital advertising that promotes the St. Boniface PSR Program. Students' names will NOT be used. *
Safe Environment/Personal Safety Video--Our diocese requires all students in grades K-8 in our schools and PSR programs be offered Safe Environment training sessions each year. The PSR program trainings are based on professional video publications selected by the diocese, focusing on personal safety at all grade levels. These trainings are designed to help our students understand how to keep themselves safe. The videos are presented as part of regular class time on various Wednesdays in the spring and take approximately 30 minutes. You may opt to have your child sit out from this presentation. *
By entering your full name below, you are effectively providing your signature to the above sections. *
Your answer
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