PLEASE PRINT OUT A COPY OF FORM USING LANDSCAPE OPTION AND MAIL IT TO THE OFFICE
ST. ROBERT BELLARMINE RELIGIOUS EDUCATION
(401) 232-9321
Office Hours: 9:00 AM - 3:30 PM
(Note: All information is kept in strict confidentiality)
Date _____/____/ 2010
STUDENT’S NAME (Last) (First) (MI) Male Female
(Please Circle)
ADDRESS___________________________________ (City)_________________________ (Zip)________
PHONE________________ CELL FAMILY E-MAIL ADDRESS____________________
Date of Birth: / / SCHOOL
GRADE (In September)______
FATHER’S NAME__________________________ MOTHER’S (FIRST & MAIDEN)_____________________
FATHER’S RELIGION______________________ MOTHER’S RELIGION_________________________
WHEN SENDING MAIL, ADDRESS TO (CHOOSE ONE):
Mr./Mrs. Mr. Mrs. Ms. Miss Dr./Mrs. Mr./Dr. other__________
IF PARENTS ARE SEPARATED OR DIVORCED, WITH WHOM DOES THE CHILD RESIDE? _________
PLEASE LIST ANY INFORMATION THAT WE SHOULD HAVE ON FILE: Learning Disabilities, Allergies,
Handicaps, etc. ________________________________________________________________________________
IF YOUR CHILD IS ENTERING THE PROGRAM FOR THE FIRST TIME,
PLEASE PROVIDE THE FOLLOWING INFORMATION:
DATE CHURCH CITY, STATE
BAPTISM ___/___/___ _________________________ ________________________
1ST COMMUNION ___/___/___ _________________________ ________________________
If your child received sacraments at another church, please forward certificates
IN THE EVENT OF AN EMERGENCY (IF WE ARE UNABLE TO REACH YOU) PLEASE CONTACT THE FOLLOWING:
Name_________________________________________ Relationship_______________________________
Address_______________________________________ City/Town _______________________________
Phone Number(s) (Home)_________________________ (Cell)___________________________________
I WISH TO REGISTER MY CHILD FOR: Please indicate GRADE IN SEPTEMBER. (circle one)
K , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10
REGISTRATION FEE: $20 PER CHILD ($50 FAMILY LIMIT). Registration Fee Waived for CCD Teachers.
Make checks payable to “St. Robert Bellarmine Church”. Registration Form and Fees can be mailed to the Religious Education Office, placed in an envelope, (marked “Religious Education”) and placed in the collection basket at weekend Masses or dropped off at the rectory during office hours.
All students enrolled in Grades 7, 8, 9, and 10 will make a retreat. Retreat Fee ($25) will be collected in the month prior to Retreat date.
There is an extra Book Fee ($15) for students in Grade 2.
The Registration period will be until July 31, 2010. Beginning August 1, 2010 there will be a late fee of $5 per child.
PARENT /GUARDIAN SIGNATURE_________________________________________________
OTHER SIBLINGS IN RELIGIOUS EDUCATIONName_______________________________ Grade_____ Name_______________________________ Grade_____ Name_______________________________ Grade_____ Are you willing to be a teacher? Yes____ No_____ If yes, what grade would you like to teach? _______ Would you like your child in your class? _______ If you cannot be a teacher, can you be a substitute teacher? Yes ____ No_____ |
+ + + + + Office Use + + + + + Date Received _____________ Payment Received _____ Check # _____ Cash _____ Registration Fee - $20 per child _____ Retreat Fee - $25 _____ Grade 2 Extra Book Fee - $15 _____ ____Outside Parish Fee - $50 _____ Late Fee (After July 31, 2010) - $5 |