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2016 - 2017 Religious Education Registration: Grades 1 thru 4
Religious Education Registration 2016-2017 (Grades 1 - 4)
Religious Education Registration 2016-2017 (Grades 1 - 4)
Name of person completing form:
First Name
MI
Last Name
Primary Phone
Email of person completing this form (for email confirmation purposes)
Child's Name
First Name
MI
Last Name
Prefers to be called/Nickname
Grade for 2016 - 2017 School Year
Kindergarten
1
2
3
4
2016 - 2017 Faith Formation Options (Check all that apply for this child)
CCS Release Time Religious Ed. (grades 1-12)
First Reconciliation/First Communion (2nd Grade)
Sunday Preschool Program (Sundays 9am Mass, ages 4-6)
Catholic School
Homeschool Faith Formation
Will not be participating
Students in grade 4 have the opportunity to become an Altar Server. Please check the box if your child is interested.
Altar Server (Grade 4+)
Preferred email(s) for correspondence (homework, liturgy notices). Separate multiple emails selecting "Add another response"
If no information about your child has changed (address, family status, etc), please indicate so, and we will use the information that you provided last year.
If information has changed please indicate so, and update/complete the new information.
Has information on this child changed from last year? (Address, sacraments, parental/family situation, special needs, etc.)
No, all information except grade is the same
Yes, information has changed for only this child
Yes, information has changed for all children in the family
A form was not filled out for this child last year
Check all that have changed
Address
Sacraments
Parental/Guardian Information
Special Needs
Address
Street Address
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
Date of Birth
Sacraments
Has child been baptized?
Yes
No
What Church and Location?
St. James, Cazenovia, NY
Other
If "other", identify Baptism church and location
Has child made First Communion?
Yes
No
What Church and Location?
St. James, Cazenovia, NY
Other
If "other", identify First Communion Church and Location
Has child made First Reconciliation?
Yes
No
What Church and Location?
St. James, Cazenovia, NY
Other
If "other", identify Reconciliation Church and Location
Has child been confirmed?
Yes
No
What Church and Location
St. James, Cazenovia, NY
Other
If "other", identify Confirmation Church and Location
Special Needs
Does this child have any special needs - such as physical handicaps, learning disabilities, behavioral needs, daily medications, medicinal allergies or dietary allergies?
Yes
No
Please identify special needs:
Parent/Guardian Information (including cell phone and email addresses)
Is the parent/guardian information the same for all children being registered in this household?
Yes
No
This child has different Parent/Guardian information than the rest of the children in the household
Have you already completed Parent/Guardian information for another child in the household for the 2015-2016 registration?
Yes
No
Parent/Guardian Information (Check all involved with raising this child)
Father
Mother
Step-Parent
Guardian
Mothers Maiden Name
Permissions
I give permission for my son/daughter to ride the bus from Burton Street, or walk to St. James from the Middle School or High School.
Yes
No
I give permission for my child to be taught the grade-level appropriate "Circle of Care" lession.(If you choose to opt out, you will be required to sign a waiver on file with the Office of Faith Formation).
Yes
No
Occasionally photos or videos may be taken at Religious Ed. I give permission for such photos/videos containing my child to be used for church purposes (St. James social media, email to parents, bulletin (hard copy and/or e-bulletin), newsletters, bulletin boards, press releases, etc.)..no names will be used in electronic correspondence.
Yes
No
This year we are collecting family photos. Please upload a family photo...it can be casual or formal, and will be used for identification purposes.
Thank you for registering your child.
Please review the above information for accuracy before submitting.
When you click the submit button, you will be taken to a page where you can register another child, or proceed to make payment.
Parent/Guardian volunteer opportunities:
Teacher
Substitute Teacher
Bake Sale
First Wednesday Mass
Class Room Assistance
Other
Need assistance with this form?
