PSR Registration

PSR REGISTRATION FORM

INSTRUCTIONS - Please fill in the required fields.

CONTACT INFORMATION

* Indicates required field

Registration Type *

New PSR Family - 1st-time Registration Existing PSR Family with new student Existing PSR Family - Information Update Only

(If you are a new family to the PSR program, make sure you have registered with the Parish before filling this form out.)

Family Name *

Street Address *

City *

Zip *

Primary Contact *

First

Last

Phone Number *

Email *

Secondary Contact *

First

Last

Phone Number *

Email *

STUDENT INFORMATION

Sacramental Information is REQUIRED if you have a new student entering the program or your family is new to the program.

1st Child *

First

Last

DOB (m/d/yy) *

Gender *

Grade *

Church of Baptism (City & State) *

2nd Child *

First

Last

DOB (m/d/yy) *

Gender *

Grade *

Church of Baptism (City & State) *

3rd Child *

First

Last

DOB (m/d/yy) *

Gender *

Grade *

Church of Baptism (City & State) *

Comments *

Submit