St. Anthony Faith Formation Registration Form

2012-2013

ALL fields below must be completed (except where noted) to submit this form

Parental Information

Fathers Last Name
Fathers First Name
Religion
Mothers Last Name
Mothers First Name
Religion
Mother’s Maiden Name
Address
City
State
Zip
E-mail
Home Phone
Other Phone

Non-custodial Parent Information (if applicable)

Non-custodial Parent Last Name
Non-custodial Parent First Name
Religion
Address
City
State
Zip
E-mail
Home Phone
Other Phone

Emergency Contact Information

Check Here to use Father's Information above:
Check Here to use Mother's Information above:

Emergency Contact Last Name
Emergency Contact First Name
Relationship to student
Home Phone
Other Phone

Below enter information for each child in your family. You may enter information for up to 5 children.

Child One

Child One's First Name
Child One's Middle Name
Child One's Last Name
Child One's Date of Birth
Child One's Gender
Child One's Age
Child One's Grade in 2012-2013
Child One's School Attending in 2012-2013
Baptism	Yes No
Reconciliation	Yes No
Eucharist	Yes No
Confirmation	Yes No

Child Two

Child Two's First Name
Child Two's Middle Name
Child Two's Last Name
Child Two's Date of Birth
Child Two's Gender
Child Two's Age
Child Two's Grade in 2012-2013
Child Two's School Attending in 2012-2013
Baptism	Yes No
Reconciliation	Yes No
Eucharist	Yes No
Confirmation	Yes No

Child Three

Child Three's First Name
Child Three's Middle Name
Child Three's Last Name
Child Three's Date of Birth
Child Three's Gender
Child Three's Age
Child Three's Grade in 2012-2013
Child Three's School Attending in 2012-2013
Baptism	Yes No
Reconciliation	Yes No
Eucharist	Yes No
Confirmation	Yes No

Child Four

Child Four's First Name
Child Four's Middle Name
Child Four's Last Name
Child Four's Date of Birth
Child Four's Gender
Child Four's Age
Child Four's Grade in 2012-2013
Child Four's School Attending in 2012-2013
Baptism	Yes No
Reconciliation	Yes No
Eucharist	Yes No
Confirmation	Yes No

Child Five

Child Five's First Name
Child Five's Middle Name
Child Five's Last Name
Child Five's Date of Birth
Child Five's Gender
Child Five's Age
Child Five's Grade in 2012-2013
Child Five's School Attending in 2012-2013
Baptism	Yes No
Reconciliation	Yes No
Eucharist	Yes No
Confirmation	Yes No

Other Child Related Information

Name of child to bring home correspondence:
Do any of the children enrolled have chronic illnesses or physical limitations?	Yes No
Do any of the children have any type of learning difficulty?	Yes No
Do any of the children attend special education classes or utilize a 504 or IEP Plan in the public school?	Yes No
If yes to any of these questions, please give the name of the child, any information we made need, and how we can help:

If you are new to our program, please indicate level of prior Faith Formation training and any other information you feel would help us in working with your child/children:

Volunteer Information

Our parish program of religious education is able to support parents in preparing children for a faith life as active Catholics because of the enthusiastic involvement of caring and faith-filled parents.

Please indicate ways and times you will help by checking the appropriate spaces for Mother, Father or both.

DESCRIPTION	Mother	Father
Serve as a catechist. Teach a class each Wednesday night from September 12-May 1. Time: 1 hour and 15 minute class, 1 hour preparation
Serve as a substitute catechist.
Serve as a classroom aide.
Serve as an aide for a special needs student.
Serve as a substitute aide.
Entrance/Hall Monitor - Supervise building halls from 6:15-6:30 pm and building entrance from 6:30-7:45 pm - 1st Quarter (Sep-Oct)
Entrance/Hall Monitor - Supervise building halls from 6:15-6:30 pm and building entrance from 6:30-7:45 pm - 2nd Quarter (Nov-Dec)
Entrance/Hall Monitor - Supervise building halls from 6:15-6:30 pm and building entrance from 6:30-7:45 pm - 3rd Quarter (Jan-Feb)
Entrance/Hall Monitor - Supervise building halls from 6:15-6:30 pm and building entrance from 6:30-7:45 pm - 4th Quarter (Mar-Apr)
Crossing guard from 7:40 - 7:45 PM - 1st Semester (Sep-Dec)
Crossing guard from 7:40 - 7:45 PM - 2nd Semester (Jan-Apr)
Classroom aide to help with special projects.
Help in office on Wednesday evenings before and after class
Accompany your child's class on a field trip.
At-home work (stuffing envelopes, cutting, etc.).
Donate food for a special occasion (1st night of class,parent mtgs., catechist gathering, class party, family events)

Consent Forms

Media Release and Authorization

By checking here, I hereby grant authority to St. Anthony Parish for the use of any videotapes, photographs, or similar items in which my child/children might appear, or statements made by them, in the production, display or sale of public service announcements.

Dual Parent Reporting

Archdiocesan Policy #5124 states, “Unless otherwise decreed in the Order of Dissolution, information commonly made available to parents of any student in attendance (i.e., notices of school/catechetical program functions, report cards, appointments for parent-teacher conferences) should be provided to both parents.” In the case of a child whose parents are in separated circumstances, a follow-up form will need to be completed and returned.

Authorization – Asthma or Airway Constricting Medication Self-Administration

As directed in ABE Policy 5141, “Students utilizing asthma or airway constricting prescription medication are allowed to administer their own dosage provided a completed consent form is on file in the school/program office.” If this issue affects you, Please fill out the consent form and return it to our offices so that the child can self administer asthma or airway constriction prescription medication.

Annual Parental/Guardian Consent Form and Liability Waiver

You must fill out and send in the Parental/Guardian Consent Form and Liability Waiver. This form is required for and serves both on-site programs and off-site/field trip events/activities for the Religious Education program year.

YOU MUST complete a paper copy of the Annual Parental/Guardian Consent Form and Liability Waiver
for EACH CHILD you are registering.
A new form needs to be filled out each year for EACH CHILD.

2012-2013 Tuition
Please complete the following but SEND NO MONEY until after August 1, 2012.
You will receive a statement in August.

The cost per student for your child’s Religious Education is over $350 per year. Your tuition fee represents about half of this cost. The parish subsidizes the remainder of the cost of your child’s Religious Education. Additional fees may be collected for retreats, rallies, and/or field trips as necessary.

Tuition for the 2012-2013 year is $185 for one child, $370 for two children, $508.75 for three children, and $601.25 for four or more children. Half of your tuition fee must be paid by January 15.

Please choose one of the following payment plans:

Tuition paid in full by September 30

Tuition paid quarterly (due by the 15th of October, December, February, April) 1 child – $46.25
2 children – $92.50
3 children – $127.18
4 or more – $150.31

Tuition paid monthly (due by the 15th of EACH month Sept.through April) 1 child – $23.13
2 children – $46.25
3 children – $63.59
4 or more – $75.16

Tuition assistance is available to those who have a need. Please note that tuition assistance will be available only to those who have completed a tuition assistance application. These applications are important to our budgeting process. Please call the Faith Formation office to obtain an application for tuition assistance.

Scrip may be purchased though St. Anthony Parish to reduce your tuition fee. Your scrip credit will be noted on your tuition bills at the end of September and February. Credit for scrip purchased after February will be carried over to the next school year. If you would like to pay your tuition in full at the beginning of the year, your scrip purchases may be designated for R.E. tuition assistance for a needy family.

If You Have Any Questions Please CONTACT US

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