Our Lady of the Snows Religious Education Program
Registration Form 2008/2009
PLEASE COMPLETE THIS FORM FOR EACH CHILD YOU ARE REGISTERING

Today's Date________________
Please check one →   Re-Registration   First Time Registration

STUDENT INFORMATION

Child's First Name _________________________________________________________

Last Name _______________________________________________________________
Male  Female

Address ________________________________________________________________

City ________________________________     State NY     Zip____________

Child's Date of Birth ________________________________

Home Telephone (______) - __________ - ____________________

How would you like mail sent? Mr. & Mrs./Mr./Mrs./Miss/Ms. _________________________________

Name of Public School child will attend in September ______________________________

Public School Grade in September 2008 ______

Religious Education Grade in September 2008 _______

Does your child have an IEP (Individual Education Plan), Learning Disability or is he/she behind in reading or writing for their grade level?  Yes    No     If yes, please explain below:

_______________________________________________________________________________________

Does your child have any allergies or health issues we should be aware of?  Yes   No.  If yes, please explain:

 _______________________________________________________________________________________

Does your child take any medications regularly?    Yes    No     If yes, please list medications below.

_______________________________________________________________________________________

HOUSEHOLD/MAILING INFORMATION   (Please be sure to complete Bolded questions)

MOTHER'S NAME:   First________________________

Maiden ________________________________   Last __________________________________

Cell Phone # ___________________________   Daytime Phone # __________________________

Religion__________________________

Address if different from child __________________________________________________

FATHER'S NAME: First________________________________________

Last_______________________________________

Circle one if father belongs to either rite
Syro Malabar, Syro Malabar Knanaya, or Syro Malankara

Cell Phone # ___________________________  Daytime Phone __________________________

Religion __________________________

Address if different from child _____________________________________________________

Parents Marital Status
Circle one: Married ,   Unmarried Living Together,   Separated,   Divorced,   Widowed,   Single

With whom does child primarily live?
Circle one:   Parents     Both Parents different households     Mother     Father     *Other

*Name of Other:_______________________________________________________________

Are there any special family situations that we should be aware of: (divorce, serious illness, deaths, etc.)

_____________________________________________________________________________

_____________________________________________________________________________

Do you as a parent need assistance in receiving a sacrament?   No   Yes, check below
Baptism   Communion   Confirmation   Marriage

Parent's Name_____________________________________

CHILD'S SACRAMENTS & RELIGIOUS EDUCATION

Has child been Baptized?   No____   Yes ____   Date_____________

Church_____________________________________________________

Received First Communion?   No____   Yes ____   Date_____________

Church_____________________________________________________

Received First Penance?   No____   Yes ____   Date_____________

Church_____________________________________________________

Has your child attended another Religious Education before?   Yes   No

When? ___________________________________

Where? ____________________________________________________________

Grade Completed : ___________________

EMERGENCY CONTACT ( REQUIRED )

Give us the name of a person we can call IF WE CANNOT REACH YOU during religion class time in the event of an emergency:

Name: ___________________________________________________

Relationship to child ______________________ Phone ___________________________

PARISH LIFE

Are you a registered parishioner of OLS?   Yes  Env. #____________   No
If no, please fill out a Parish Registration Form.

Are you involved in any parish ministry?   Yes   No

If so, what ministry?__________________________________________________

If no, would you like to be?   Yes   No

What might interest you? ____________________________________________________

Would you like to be involved in Family Mass?   Yes   No

Would you like to be a Catechist?   Yes   No
Substitute Catechist?   Yes   No

COMMITMENT & RESPONSIBILITY

It is our understanding that you will take seriously your responsibility to attend Mass each weekend with your child and that your child will attend religious instruction class regularly.

Parent/Guardian Signature_________________________________________________________________

Can we call on you for parental help for our Program?  Yes   No