St. Francis Xavier 2012-2013 PSR Student Registration Form
Please complete one form per family (Grades 4K-12)

4K students must be 4 years old by September 1, 2012
5K students must be 5 years old by September 1, 2012

Registration Fee: $35 per child / $90 family maximum
Non-parishioners: $50 per child

Registration fees may be paid by check to the Office of Religious Education or through our Online Giving service at https://www.myowngiving.com/Default.aspx?cid=318 - Thank you!
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Parent Information
Family Last Name
Father's Name
Mother's Name
Marital Status of Parents
If parents are separated or divorced, are there any custody issues which teachers should be aware of?
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If yes, please explain:
Father's address
Mother's address
Father's home phone
Mother's home phone
Father's work phone
Mother's work phone
Father's cell phone
Mother's cell phone
Father's email address
Mother's email address
PSR correspondence should be addressed to
Email address checked most frequently
We are registered members of SFX and have completed the parish census card
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