Parish Religious Education Program New Student Registration Levels 1-8

Automated Message

We utilize an automated phone and email messaging system for class cancellations, schedule changes, and important reminders. Please list the email address and phone number(s) you would like us to use for messages regarding cancellations and reminders.

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Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Alternate Phone Number Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Additional Email Please enter an email address.

Due to current circumstances regarding Covid-19, our 2021-2022 program may continue virtually on Sunday evenings, but we prayerfully hope to meet again in-person.
For now, please place a mark beside the in-person program you prefer. We will notify you with additional information as soon as we can.

Registering For REQUIRED Wednesday Evening Class Sunday Family and Faith Program (1x month +homework) Please fill out this field.

Family Home Parish REQUIRED Saint Theresa Parish Other Please fill out this field.

If Other, provide parish name: Please enter valid data.

Name of Person Filling Out Form REQUIRED Please fill out this field. Please enter valid data.

Family Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Family Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Mother's Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Religious Affiliation REQUIRED Please fill out this field. Please enter valid data.

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Father's Religious Affiliation REQUIRED Please fill out this field. Please enter valid data.

Emergency Information

Please provide the following information in the event of an emergency. I authorize the staff of Saint Theresa to seek emergency medical care for my child as deemed appropriate

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Relationship REQUIRED Please fill out this field. Please enter valid data.

Physician's Name REQUIRED Please fill out this field. Please enter valid data.

Physician's Phone REQUIRED Please fill out this field. Please enter valid data.

Hospital Preference REQUIRED Please fill out this field. Please enter valid data.

Volunteer Opportunities

Our program is volunteer based. Please consider helping in one of the following areas:

Catechist (Teacher) Substitute Catechist Classroom Aide Building Monitor (Wed evenings, about 1x month)

Comments/Concerns: Please enter valid data.

In registering my child for Saint Theresa Religious Formation, I acknowledge that I have a responsibility, as the primary faith educator of my child, to support the teaching of religion and to assist my student's education by our family practice of prayer and good works, observing the Law of God and attending Mass each Sunday and Holy Day. I agree to abide by the policies in the parent handbook.

Signature (Indicate parent name as electronic signature) REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

2021-2022 REGISTRATION FEES
EARLY REGISTRATION - by May 1, 2021 (discounted):
One Child - $50;
Two Children - $70;
Three Children - $85
REGULAR REGISTRATION - by July 31, 2021:
One Child - $90;
Two Children - $110;
Three Children - $130
LATE REGISTRATION - AFTER August 1, 2021 (includes a late fee):
One Child - $100;
Two Children - $125;
Three Children - $150.

Payment REQUIRED Cash Check Online Payment Please fill out this field.

Check # Please enter valid data.

Amount: Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

Payment by credit card can be made online by going to "Online Giving" on the parish home page (www.saintheresaparish.org). There you will be able to enter the amount due beside “Rel Education.”

Student Information. Complete information for each child.