St.

Michael Parish School of Religion (PSR) Family Registration Information form 2015-2016
preferred family name: _______________________________

new or existing family? : ____________

Parent/Guardian information
last name

first name

email

_________________________

_____________________

____________________________________

______________

mother
_________________________
mother maiden name ______________________

_____________________

____________________________________

______________

child(ren) lives with: ____________________

family status: _________________________

father

religion

parish: ____________________________

address of primary custodial parent:_________________________________________ city/state:_________________________ zip:__________________

PHONE CONTACTS

1 ______________________ home
2 ______________________ mom cell

4 ______________________ dad cell

ok to send text messages?

3 ______________________ mom work

ok to send text messages?

5 ______________________ dad work

6 ______________________ other: ___________________

Student Name:
last name: _______________ first name: ____________ nickname: ____________

middle: ______________

dob: ____________

student cell (if applicable): ____________________ student email (if applicable): _____________________________ grade: __________
Sacraments:
Baptism
______________ ____________________
baptismal certificate on file at St. Michael? _______________
received:
date
church name/location
1st Reconciliation
______________ ____________________
name of school : __________________
Eucharist
Confirmation

date

church name/location

date

church name/location

date

church name/location

______________

____________________

______________ ____________________

catholic? ______________________
# of years attended PSR at St. Michael: __________________

Student Name:
last name: ______________________________ first name: _____________________ middle: ______________

dob: ____________

student cell (if applicable): ____________________ student email (if applicable): _____________________________ grade: __________
Sacraments:
Baptism
______________ ____________________
baptismal certificate on file at St. Michael? _______________
received:
date
church name/location
1st Reconciliation
______________ ____________________
name of school : __________________
Eucharist
Confirmation

date

church name/location

date

church name/location

date

church name/location

______________

____________________

______________ ____________________

catholic? ______________________
# of years attended PSR at St. Michael: __________________

Student Name:
last name: ______________________________ first name: _____________________ middle: ______________

dob: ____________

student cell (if applicable): ____________________ student email (if applicable): _____________________________ grade: __________
Sacraments:
Baptism
______________ ____________________
baptismal certificate on file at St. Michael? _______________
received:
date
church name/location
1st Reconciliation
______________ ____________________
name of school : __________________
Eucharist
Confirmation

date

church name/location

date

church name/location

date

church name/location

______________

____________________

______________ ____________________

catholic? ______________________
# of years attended PSR at St. Michael: __________________

St. Michael Girard Parish School of Religion (PSR)

Volunteer Form 2015-2016
The overall success of our PSR program is dependent on the support and generosity of parent volunteers. Volunteering is a
wonderful way to show your children that PSR is important, to set a positive example, and to illustrate living your faith. Please review this list
and indicate those ways in which you are able to share your time and talent.

name ___________________________________

email ______________________________

home phone _____________________________

cell/work ____________________________

I WOULD LIKE TO HELP IN THE FOLLOWING AREAS:

______ catechist:
______ substitute catechist:
______ classroom aide:

Sunday or evening?__________
Sunday or evening?__________
Sunday or evening?__________

______ childrens Christmas program

______ childrens music ministry
______ service projects (volunteer to plan and implement service projects for the children or youth)
______ special events helper or planner
______ May Crowning/8th grade recognition
______ parish picnic/PSR fall bash
______ driver for fieldtrips or chaperone for youth events
______ childrens Easter egg hunt;
______ Totus Tuus (vacation bible school)
______ Lenten Stations of the Cross prayer service
Please note that all volunteers who work with children & youth are required to attend the VIRTUS program Protecting Gods
Children, along with a background check. The program is offered many times at our parish and at other parishes in our diocese. NO ONE
will be allowed in the classes without the proper authorization.

WE THANK YOU FOR YOUR SERVICE TO OUR YOUTH AND OUR PARISH!

Media Authorization
I hereby authorize St. Michael Catholic Church, Girard, KS, the Catholic Diocese of Wichita, and its agents to utilize photographic and/or video
images of me or my child. In giving my consent, I hereby indemnify and hold harmless St. Michaels Church, Girard, the Catholic Diocese of
Wichita and its agents from any and all responsibility or liability. I understand that I will receive no compensation, should any photograph and/or
video of me or my child be used.
individuals name(s):

_________________________________________________________

signature of parent(s)/guardian(s)* __________________________________________________

printed name:

date _______________

__________________________________________________

*required if participant is under 18

please check here if you do not give authorization

childs name: __________________________________
__________________________________
grade: __________________________________

Fee Information
one child: $10.00

two or more children: $20.00

**please make your check out to St. Michael PSR and return along with this enrollment form.

Office use only:

paid:

_______________

date:

_______________

cash

check