Religious Education Registration 2020-21 Step 1 of 6 16% Student Name* First Nickname Last Student Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Parent's Primary Email* Date of Birth* Date Format: MM slash DD slash YYYY School Grade in Sept. 2020*Rel. Ed. Grade in Sept. 2020*Name of School for 2020-21*Which program will you be attending:*---Regular ClassesAt-home / Sunday ProgramWould you like to add a second student?*YesNoSecond Student's Name* First Nickname Last Is the second students address the same?YesNoSecond Student's Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Second Student's Home Phone*Second Child's Date of Birth* Date Format: MM slash DD slash YYYY Second Student's School Grade in Sept. 2020*Second Students Rel. Ed. Grade in Sept. 2020*Second Student's Name of School for 2020-21*Which program will the second student be attending:*---Regular ClassesAt-home / Sunday ProgramWould you like to add a third student?*YesNoIs the third students address the same?YesNoThird Student's Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Third Student's Home Phone*Third Child's Date of Birth* Date Format: MM slash DD slash YYYY Third Student's School Grade in Sept. 2020*Third Students Rel. Ed. Grade in Sept. 2020*Third Student's Name of School for 2020-21*Which program will the third student be attending:*---Regular ClassesAt-home / Sunday ProgramWould you like to add a fourth student?*YesNoIs the fourth students address the same?YesNoFourth Student's Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Fourth Student's Home Phone*Fourth Child's Date of Birth* Date Format: MM slash DD slash YYYY Fourth Student's School Grade in Sept. 2020*Fourth Students Rel. Ed. Grade in Sept. 2020*Fourth Student's Name of School for 2020-21*Which program will the fourth student be attending:*---Regular ClassesAt-home / Sunday ProgramWould you like to add a fifth student?*YesNoIs the fifth students address the same?YesNoFifth Student's Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Fifth Student's Home Phone*Fifth Child's Date of Birth* Date Format: MM slash DD slash YYYY Fifth Student's School Grade in Sept. 2020*Fifth Students Rel. Ed. Grade in Sept. 2020*Fifth Student's Name of School for 2020-21*Which program will the fifth student be attending:*---Regular ClassesAt-home / Sunday Program Father's InformationName First Last ReligionOccupationCell PhoneCell Phone ProviderWork Phone Mother's InformationMother's Name First Last ReligionOccupationMother's Maiden Name (Needed for Sacramental Record Books) Last Cell PhoneCell Phone ProviderWork Phone With whom does the student live? (Select One)---Both ParentsMother OnlyFather OnlyOne parent, one step-parentOtherPlease explainHow should correspondence be addressed---Mr. & Mrs.Mrs.Mr.Ms.OtherPlease explainShould correspondence be sent to multiple parties? If so, please give instructions:Are you a registered parishioner at St. Leo the Great Parish?*YesNoWant to RegisterIf not, to which parish do you belong?Did your child attend St. Leo’s Religious Education Program last year?*---YesNoIf your child was not in St. Leo’s Religious Education Program last year and was baptized at a parish other than St. Leo’s, please attach a copy of his/ her baptismal certificate.Was your child baptized at St. Leo?*---YesNoPlease attach a copy of their Baptismal CertificateParish, City, & Date of BaptismParish, City, & Date of ReconciliationParish, City, & Date of EucharistBrothers and Sisters (Names & Ages):Emergency Contact Name (If parents cannot be reached) First Last Emergency Contact PhoneEmergency Contact Relationship PaymentParishioner’s Fee*One Child $60.00Two Children $100.003 or more Children $140.00Catechist WaiverFinancial HardshipNon-parishioner’s fee Price: $90.00 Quantity: Total $0.00 Student Full Name* First Middle Last Please inform us of any medical conditions, learning disabilities, etc. that might bear on your child’s performance in class or behavior, or that would better enable us to serve your child. (for example-- epilepsy, allergies, diabetes, reading difficulties, A.D.H.D., etc.)*Video / Photograph / Media Release - Permission is requested for your child to be photographed or videotaped at classes/ events associated with St. Leo the Great Parish and the Religious Education Program. These photos, videos, etc. may be used in the church bulletin, on the parish website or published in the newspaper or other publications. The videos or pictures may be used for information or educational purposes regarding the programs or events at St. Leo the Great Parish.*Yes, I give my permission for my child to be photographed, videoed, etc.I do not give my permission for my child to be photographed, videoed, etc.Annual People Safety Awareness Training for Children - In today’s society we are aware of the increased need to protect our children from harm. In an effort to ensure the well-being of our young people, the Diocese of Buffalo trains and screens all adult staff and volunteers that work with youth. Additionally the Diocese has implemented a program to train our children in “people safety”. This training, mandated by the Diocese of Buffalo, will be conducted for the religious education students at St. Leo the Great Parish during a regular class session. The training is a way for your child to learn to recognize and respond appropriately and assertively to personal safety issues at an age appropriate level. Please feel free to call me at 835-8905 x 12 if you have any questions, concerns, or would like additional information regarding this instruction. Please indicated below whether or not you wish for your child to take part in this age-appropriate personal safety session.*I give my child permission to take part in the annual People Safety Awareness session at St. Leo’s.I ask that my child be excused from attending the People Safety Awareness session at St. Leo’s.Would you like to add a second student?YesNoSecond Student Full Name First Middle Last Second Child - Please inform us of any medical conditions, learning disabilities, etc. that might bear on your child’s performance in class or behavior, or that would better enable us to serve your child. (for example-- epilepsy, allergies, diabetes, reading difficulties, A.D.H.D., etc.)*Second Child - Video / Photograph / Media Release - Permission is requested for your child to be photographed or videotaped at classes/ events associated with St. Leo the Great Parish and the Religious Education Program. These photos, videos, etc. may be used in the church bulletin, on the parish website or published in the newspaper or other publications. The videos or pictures may be used for information or educational purposes regarding the programs or events at St. Leo the Great Parish.*Yes, I give my permission for my child to be photographed, videoed, etc.I do not give my permission for my child to be photographed, videoed, etc.Would you like to add a third student?YesNoThird Student Full Name First Middle Last Third Child - Please inform us of any medical conditions, learning disabilities, etc. that might bear on your child’s performance in class or behavior, or that would better enable us to serve your child. (for example-- epilepsy, allergies, diabetes, reading difficulties, A.D.H.D., etc.)*Third Child - Video / Photograph / Media Release - Permission is requested for your child to be photographed or videotaped at classes/ events associated with St. Leo the Great Parish and the Religious Education Program. These photos, videos, etc. may be used in the church bulletin, on the parish website or published in the newspaper or other publications. The videos or pictures may be used for information or educational purposes regarding the programs or events at St. Leo the Great Parish.*Yes, I give my permission for my child to be photographed, videoed, etc.I do not give my permission for my child to be photographed, videoed, etc.Would you like to add a forth student?YesNoFourth Student Full Name First Middle Last Fourth Child - Please inform us of any medical conditions, learning disabilities, etc. that might bear on your child’s performance in class or behavior, or that would better enable us to serve your child. (for example-- epilepsy, allergies, diabetes, reading difficulties, A.D.H.D., etc.)*Fourth Child - Video / Photograph / Media Release - Permission is requested for your child to be photographed or videotaped at classes/ events associated with St. Leo the Great Parish and the Religious Education Program. These photos, videos, etc. may be used in the church bulletin, on the parish website or published in the newspaper or other publications. The videos or pictures may be used for information or educational purposes regarding the programs or events at St. Leo the Great Parish.*Yes, I give my permission for my child to be photographed, videoed, etc.I do not give my permission for my child to be photographed, videoed, etc.Would you like to add a fifth student?YesNoStudent Full Name First Middle Last Please inform us of any medical conditions, learning disabilities, etc. that might bear on your child’s performance in class or behavior, or that would better enable us to serve your child. (for example-- epilepsy, allergies, diabetes, reading difficulties, A.D.H.D., etc.)*Fifth Child - Video / Photograph / Media Release - Permission is requested for your child to be photographed or videotaped at classes/ events associated with St. Leo the Great Parish and the Religious Education Program. These photos, videos, etc. may be used in the church bulletin, on the parish website or published in the newspaper or other publications. The videos or pictures may be used for information or educational purposes regarding the programs or events at St. Leo the Great Parish.*Yes, I give my permission for my child to be photographed, videoed, etc.I do not give my permission for my child to be photographed, videoed, etc.Full name of parent or guardian filling out this form*Total $0.00 Credit Card Card Details Cardholder Name
