PSR Student Registration 2018-19

PSR Registration Information

Use the PSR Family Registration Form for ALL children in Kindergarten through 8th Grade.  We will contact you by email with your child's class placement in early August.

If you are new to the parish, please take a moment to complete and submit a New Parishioner Registration Form.

If you are not a member of the parish but would like permission to attend our PSR Program, please contact the program coordinator at 618-281-5105 ext.352

 

2018-19 P.S.R. REGISTRATION (K - 8th grade)

We are happy that you have chosen Immaculate Conception PSR and it's various educational, social and outreach opportunities.

Family Information:

ex: Smith

Street, City, State, Zip Code

Father's Information

Last, First

Mother's Information

Last, First

In the absence of a court order that states otherwise, Immaculate Conception will communicate to both the custodial and the non-custodial parent, any information regarding faith formation for their child(ren). Please understand it is the responsibility of the custodial parent to provide us with an official copy of the court order.

Emergency Contact(s) other than parents (2 names are required)

aunt, uncle, grandparent, friend, etc.

aunt, uncle, grandparent, friend, etc.

Student Information (complete for each child registering)

Please provide us with any information (Medical conditions such as asthma, anaphylactic allergies, asthma, dietary restrictions, or learning disabilities such as autism spectrum, sensory, behavioral, emotional, social, attention differences, etc.) that will help us to place your child in the best environment.

Last, First

ex: 4/8/2008

If other than ICC a copy of Baptism Certificate is required.

Asthma, allergies, food restrictions?

Prescriptions, dosages?

Disabilities or special needs


Last, First

ex: 4/8/2008

If other than ICC a copy of Baptism Certificate is required.

Asthma, allergies, food restrictions?

Prescriptions, dosages?

Disabilities or special needs?


Last, First

ex: 4/8/2008

If other than ICC a copy of Baptism Certificate is required.

Asthma, allergies, food restrictions?

Prescriptions, dosages?

Disablilities or special needs?


Last, First

ex: 4/8/2008

If other than ICC a copy of Baptism Certificate is required.

Asthma, allergies, food restrictions?

Prescriptions, dosages?

Disabilities or special needs?

Photograph Release

Safe Touch Personal Safety Video

 
 

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