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2024 Registration Form

- Rel. Ed.

Religious Education Program Registration
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- St. Gregory the Great PREP Registration
  
  All New Students & 1st Graders are required to provide a copy of their Baptismal records. Please email copies of baptismal records to [email protected] Penance & Communion records are required, if applicable.
- Parish Envelope # REQUIRED Please fill out this field. Please enter valid data.
- Select one REQUIRED Please fill out this field.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- How many students does your family have in St. Gregory the Great PREP? Please enter an integer (number).
- Family Name REQUIRED Please fill out this field. Please enter valid data.
- 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.
- Emergency Contact Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- How many children are you registering? REQUIRED Please fill out this field.
  
  Child 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade as of September 2023? REQUIRED Please fill out this field. Please enter valid data.
  
  School? REQUIRED Please fill out this field. Please enter valid data.
  
  Special Concerns/Needs (Please provide a copy of IEP or 504 if available) REQUIRED Please fill out this field.
  
  Child 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade as of September 2023? REQUIRED Please fill out this field. Please enter valid data.
  
  School? REQUIRED Please fill out this field. Please enter valid data.
  
  Special Concerns/Needs (Please provide a copy of IEP or 504 if available) REQUIRED Please fill out this field.
  
  Child 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade as of September 2023? REQUIRED Please fill out this field. Please enter valid data.
  
  School? REQUIRED Please fill out this field. Please enter valid data.
  
  Special Concerns/Needs (Please provide a copy of IEP or 504 if available) REQUIRED Please fill out this field.
  
  Child 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade as of September 2023? REQUIRED Please fill out this field. Please enter valid data.
  
  School? REQUIRED Please fill out this field. Please enter valid data.
  
  Special Concerns/Needs (Please provide a copy of IEP or 504 if available) REQUIRED Please fill out this field.
  
  Child 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade as of September 2023? REQUIRED Please fill out this field. Please enter valid data.
  
  School? REQUIRED Please fill out this field. Please enter valid data.
  
  Special Concerns/Needs (Please provide a copy of IEP or 504 if available) REQUIRED Please fill out this field.
  
  Child 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade as of September 2023? REQUIRED Please fill out this field. Please enter valid data.
  
  School? REQUIRED Please fill out this field. Please enter valid data.
  
  Special Concerns/Needs (Please provide a copy of IEP or 504 if available) REQUIRED Please fill out this field.
  
  Child 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade as of September 2023? REQUIRED Please fill out this field. Please enter valid data.
  
  School? REQUIRED Please fill out this field. Please enter valid data.
  
  Special Concerns/Needs (Please provide a copy of IEP or 504 if available) REQUIRED Please fill out this field.
  
  Child 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade as of September 2023? REQUIRED Please fill out this field. Please enter valid data.
  
  School? REQUIRED Please fill out this field. Please enter valid data.
  
  Special Concerns/Needs (Please provide a copy of IEP or 504 if available) REQUIRED Please fill out this field.
  
  Child 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade as of September 2023? REQUIRED Please fill out this field. Please enter valid data.
  
  School? REQUIRED Please fill out this field. Please enter valid data.
  
  Special Concerns/Needs (Please provide a copy of IEP or 504 if available) REQUIRED Please fill out this field.
  
  Child 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade as of September 2023? REQUIRED Please fill out this field. Please enter valid data.
  
  School? REQUIRED Please fill out this field. Please enter valid data.
  
  Special Concerns/Needs (Please provide a copy of IEP or 504 if available) REQUIRED Please fill out this field.
- Mother's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name (If applicable) REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Mother's Religion REQUIRED Please fill out this field. Please enter valid data.
- Father's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Father's Religion REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Acknowledgements/Permissions
  
  Authorization for St. Gregory's to use photos of our child to post on our bulletin board and our secure website.
  I Agree Please select this field.
  
  I give permission for my child to walk to St. Gregory's Church for Sacramental Practices, Mass or Penance.
  I Agree Please select this field.
  
  Parents of 5th & 6th Grade Students only:
  By providing the name of your child in the box below, you hereby give permission for your child to be dismissed without a parent. St. Gregory’s is not responsible for the safety of students once they have been dismissed from the classroom.
  
  Child's Name Please enter valid data.
  
  In Case of Accident or Illness:
  I request that the parish representative contact me. If I am unable to be reached, I hereby authorize this representative to make whatever arrangements seem necessary. I agree to assume financial responsibility for any diagnosis, treatment and/or medication deemed necessary.
  
  I Agree Please select this field.
  
  To the best of my knowledge, and by submitting this form, I affirm that all information given is accurate and complete. I hereby consent to and authorize procedures that have been stated above.
  
  I Agree Please select this field.
  
  Name of person submitting this form? REQUIRED Please fill out this field. Please enter valid data.
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