2024-2025 PRE Registration - E
Today's Date
Today's Date
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Student Information
Student Last Name
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Student First Name
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Name Student Goes By
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Student Middle Name
Student Suffix
Gender
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Male
Female
Age (As of 8/1/2024)
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Grade Attending (Fall 2024)
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School Attending
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Birth Date
Birth Date
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Birthplace
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Grade Level of Religious Education Student Has Completed (Select All)
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Grade Level of Religious Education Student Has Completed (Select All)
K
1
2
3
4
5
6
7
8
9
10
11
Address
Address
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Address Line 1
Address Line 2
City
State
Select a State
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
Zip Code
Family Email
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Parish Where Registered
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Family Information (Father)
Father / Guardian / Stepfather (Select One)
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Father
Guardian
Stepfather
Father / Guardian / Stepfather Last Name
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Father / Guardian / Stepfather First Name
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Father / Guardian / Stepfather Work Number
Father / Guardian / Stepfather Work Number
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Father / Guardian / Stepfather Cell Phone
Father / Guardian / Stepfather Cell Phone
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Father / Guardian / Stepfather Email
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Father / Guardian / Stepfather Religion
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Family Information (Mother)
Mother / Guardian / Stepmother (Select One)
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Mother
Guardian
Stepmother
Mother / Guardian / Stepmother Last Name
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Mother / Guardian / Stepmother First Name
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Mother / Guardian / Stepmother Work Number
Mother / Guardian / Stepmother Work Number
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-
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Mother / Guardian / Stepmother Cell Phone
Mother / Guardian / Stepmother Cell Phone
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-
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Mother / Guardian / Stepmother Email
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Mother / Guardian / Stepmother Religion
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Marital Status (Select One)
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Married
Separated
Divorced
Widowed
Student Resides With (Select One)
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Both Parents
Mother
Father
Guardian
Family Members in RCIA? (Rite of Christian Initiation of Adults)
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Family Members in RCIA? (Rite of Christian Initiation of Adults)
Yes
No
If Family Members in RCIA, Specify with Relationship
Sacraments Received
Sacraments Received (Select One)
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Sacraments Received (Select One)
Catholic Baptism
Protestant Baptism
Not Baptized
Sacraments Needed
Sacraments Needed (Select All That Apply)
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Sacraments Needed (Select All That Apply)
Baptism
First Reconciliation
First Eucharist
Confirmation
Sacrament preparation is a two year process. Each child must have been enrolled in a Catholic school or PRE program last year in order to receive a sacrament this year.
Health Information
Does the Student have any health conditions or have Special Needs?
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Does the Student have any health conditions or have Special Needs?
Yes
No
If yes, please explain
Is the Student taking any medications?
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Is the Student taking any medications?
Yes
No
If yes, please list
Is the Student allergic to any FOODS or MEDICINES?
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Is the Student allergic to any FOODS or MEDICINES?
Yes
No
If yes, please specify
• I authorize the St. Philip’s Staff to summon emergency medical treatment in the event my child (children) becomes seriously ill or injured, and I further release St. Philip’s Staff and the Diocese of Memphis from any and all liability and waive any claims against them in regard to any accident or injury by participation in any activities of a St. Philip the Apostle program.
(Choose One)
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(Choose One)
I agree
I do NOT agree
• My signature gives St. Philip the Apostle Church permission to photograph or videotape my child at St. Philip’s P.R.E. or any P.R.E. activity. This photo may be published in the newspaper, church website or weekly bulletin. *(If not, please attach your decline in writing.)
(Choose One)
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(Choose One)
I agree
I do NOT agree
• The Virtus Touching Safety Program for Children will be presented in the Religious Education Program each year. This program is an implementation of the Charter for the Protection of Children and Young People adopted in 2002 by our nation's bishops. Note: Any parent is permitted to "opt out" of the Virtus Touching Safety Program for Children, excluding their child from this presentation. To opt out, please contact the Religious Education Office.
(Choose One)
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(Choose One)
I agree
I do NOT agree
• DISCLAIMER: By submitting this form electronically, you are also signing the form electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.
(Choose One)
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(Choose One)
I agree
I do NOT agree
Date Paid: ____________ Amount Paid: ____________ Cash ______ Check ______ ** Office Use Only **