R.E.P. Form

Please fill out this form to regester for the St. Paul the Apostle Religious Education program.

Sunday School (3 years old by September 1, 2013 - Kindergarten)

Religious Education Program (Grades 1-6)  Choose preferred time below

Jr. High School Youth Group (Grades 7-8)

Sr. High School Youth Group (Grades 9-12)


This form MUST be submitted by the last week of August.

    • Preferred Time
      (For Grades 1-6 only)
      Tuesday 4:30-5:30
      Tuesday 6-7 pm
    • Parent(s) First Name*
       
    • Parent(s) Last Name*
       
    • Address*
        (Number and Street)
    • City*
       
    • State*
       
    • Zip Code*
       
    • Home Phone*
       
    • Cell Phone*
       
    • E-Mail*
       
    • Were Children Enrolled Last Year?*
      Yes
      No
    • If yes, then where
       
    • Additional Information
      Add anything not covered in parent information.
    •  
  • Student Information
    • First and Last Name*
        1st Student
    • Birth Date*
        1st Student
    • Grade*
        1st Student
    • School*
        1st Student
    • Gender*
        1st Student
    • Sacraments Received*
        1st Student, seperated with commas
    • Enrollment group*
       
    • First and Last Name
        2nd Student
    • Birthday
        2nd Student
    • Gender
        2nd Student
    • Grade
        2nd Student
    • School
        2nd Student
    • Sacraments Received
        2nd Student, seperated with commas
    • Enrollment group
       
    • First and Last Name
        3rd Student
    • Birthday
        3rd Student
    • Gender
        3rd Student
    • Grade
        3rd Student
    • School
        3rd Student
    • Sacraments Received
        3rd Student, seperated with commas
    • Enrollment group
       
    • First and Last Name
        4th Student
    • Birthday
        4th Student
    • Gender
        4th Student
    • Grade
        4th Student
    • School
        4th Student
    • Sacraments Received
        4th Student, seperated with commas
    • Enrollment group
       
    • Additional Information
      More students
    • In this box, list all medical information about each child. Please also include allergies, current medications, whether they wear glasses or contacts, and any disabilities.
    • Family Physician's Name*
       
    • Family Physician's Phone*
       
    • Health Insurance Company*
       
    • Health Insurance Contract #*
       
    • Health Insurance Group #*
       
    • Health Insurance Policy #*
       
    •  
  • Release
    As legal guardian, I hereby authorize first aid/medical treatment for my above said children, in the event of an emergency, which may endanger his/her life, cause disfigurement, physical impairment or undue discomfort if delayed. It is understood that efforts will be made to contact the person listed on this form as soon as reasonably possible. In the event that the aforementioned requires my authorization for treatment and I cannot be reached in an emergency, I hereby give me permission to the physician selected by the activity leader to hospitalize, secure medical treatment, and/or order an injection, anesthesia or surgery for the aforementioned as deemed necessary. I understand all reasonable safety precautions will be taken at all times by the parish and its agents during Formation Programing. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold the St. Paul the Apostle Church (parish), its leaders, employees, drivers, volunteers, or the Roman Catholic Diocese of Grand Rapids liable for damages, losses, dieases, or injuries incurred by the aforementioned.
    • I agree to the above Medical Treatment Release*
      Yes, I agree
    •  
  • Security Code*

    (Enter the code above)
  •  
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