Date Received _____________________
Registrations Due July 1
Amount Rec’d ____________Check # ________
Saint Mary Star of the Sea Religious Education Program
2015-2016 Registration Form
Grades 1-8
Part I-Contact Information
Please Print & fill out Complete form
Father’s Full Name _______________________________________________________
Religion_________________________________
Mother’s Full Name ______________________________________________________
Religion ________________________________
Mother’s Maiden Name _________________________________________________
Name & Address for Mailing purposes __________________________________________________
_________________________________________________________________________________________________________________________
Home Phone ___________________________________________________
Cell Phone: Dad ______________________
Cell Phone: Mom ____________________________
Parent’s Email Address 1.________________________________________ 2. _______________________________________________
In an emergency if I cannot be reached at home or on my cell then contact:
Name ___________________________________________ Phone ___________________________________
Please check here if you are registering for the first time
Part II- Student Information
First Child’s Full Name____________________________________________________ Gender M
F
DOB ___________________Religious Education grade 2015-16 __________ School grade 2015-16 ________
Date of Baptism _______________________________ Church of Baptism _____________________________
My child has received First Eucharist Yes / No
Special Needs (learning disabilities, allergies etc.) _________________________________________________
Second Child’s Full Name__________________________________________________ Gender
M
F
DOB ___________________Religious Education grade 2015-16 __________School grade 2015-16 __________
Date of Baptism _______________________________ Church of Baptism _____________________________
My child has received First Eucharist Yes / No
Special Needs (learning disabilities, allergies etc.) _________________________________________________
Third Child’s Full Name_______________________________________________________ Gender M
F
DOB ___________________Religious Education grade 2015-16 ___________ School grade 2015-16 ________
Date of Baptism _______________________________ Church of Baptism _____________________________
My child has received First Eucharist Yes / No
Special Needs (learning disabilities, allergies etc.) _________________________________________________
Tuition: Discount if paid by July 1
Late Fee after July 1
$80.00/ one child
$155.00/ two children
$225.00/ three children
$250.00/ family max
$90.00/ one child
$165.00/two children
$235.00/ three children
$260.00/ family max
Make Checks payable to: St. Mary Star of the Sea Parish
Mail to: Collaborative Offices
Attn Religious Education
552 Cabot St.
Beverly, MA 01915
Time schedule
978-922-0113
(please circle first choice for placements grades 1-6)
Grades 1-5
Sunday 9:30—10:30AM
or
Grades 6-8
Sunday 9:30-10:30AM Only
Wednesday 3:30-4:30PM
You will be contacted ONLY if there is a problem with space availability
Photo release: Please understand that your child(ren) may be photographed/videotaped
during Religious Education activities for use in parish presentations and promotional material.
If you do NOT want your child photographed/videotaped please contact the Religious
Education office to sign a waiver.
__________________________________________________________________________________________
We need your help. Please consider volunteering in the Religious Education program as one of
the following. If interested check below
______Hall monitor
_______ Aide
______ Substitute Catechist
______ Catechist
As a legal parent/guardian I confirm that I have read, understand and answered all of the
information on this form honestly and accurately to the best of my ability.
Parent Signature_____________________________________________ Date _____________