St. Stephen Parish Religious Education STUDENT Registration 2019 - 2020

Register your child(ren) in all St. Stephen Religious Education classes for the 2020 - 2021
Faith Formation Year using this form.

St. Stephen Religious Education classes include:
-3-4-5 Church (Children ages 3-5)
-Catechesis of the Good Shepherd (Children Ages 3-6, 6-9, 9-12)
-PREP grades K-6
-EDGE Catholic Middle School Ministry (Students in Grades 7-8)
-Special Needs Ministry

Contact Gregory Karn ( gkarn@ssccohtn.org ) for help with any specific questions)

NOTE: You May Register Up to 6 Children on this Form

FIRST Parent or Legal Guardian's Name FIRST Parent or Legal Guardian's Name First Last
Email Address - MUST HAVE!
Phone Number Phone Number - ### - ### ####
FIRST Parents Religion
SECOND Parent or Legal Guardian's Name SECOND Parent or Legal Guardian's Name First Last
Email
Phone Number Phone Number - ### - ### ####
SECOND Parent's Religion
Emergency Contact Name
(In the event of an emergency, and we cannot reach you) Emergency Contact Name
(In the event of an emergency, and we cannot reach you) First Last
Emergency Contact Phone Number Emergency Contact Phone Number - ### - ### ####
Are You Members of St. Stephen Catholic Community? (Membership Not
Required for Registration.)

Are You Members of St. Stephen Catholic Community? (Membership Not
Required for Registration.) yes no
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
How Many Children are you Registering?
Child 1 Legal Name Child 1 Legal Name First Last
Child 1 Name (what they prefer to be called) Child 1 Name (what they prefer to be called) First Last
Child 1 age
Child 1 date of birth Child 1 date of birth / MM / DD YYYY
Child 1 Gender

Child 1 Gender Male Female
Child 1 School
Grade Child 1 will ENTER Fall of 2019.
Has Child 1 been Baptized

Has Child 1 been Baptized Yes No
Date and Location Child 1 was Baptized
Do You Need Assistance in Arranging Child 1's Baptism?

Do You Need Assistance in Arranging Child 1's Baptism? Yes No

Child 1 Has Received the Following Sacraments?
	Yes	No
First Reconciliation	First ReconciliationYes	First ReconciliationNo
First Eucharist	First EucharistYes	First EucharistNo
Confirmation	ConfirmationYes	ConfirmationNo

Child 2 Legal Name Child 2 Legal Name First Last
Child 2 Name (what they prefer to be called) Child 2 Name (what they prefer to be called) First Last
Child 2 age
Child 2 date of birth Child 2 date of birth / MM / DD YYYY
Child 2 Gender

Child 2 Gender Male Female
Child 2 School
Grade Child 2 will ENTER Fall of 2019.
Has Child 2 been Baptized

Has Child 2 been Baptized Yes No
Date and Location Child 2 was Baptized
Do You Need Assistance in Arranging Child 2's Baptism?

Do You Need Assistance in Arranging Child 2's Baptism? Yes No

Child 2 Has Received the Following Sacraments?
	Yes	No
First Reconciliation	First ReconciliationYes	First ReconciliationNo
First Eucharist	First EucharistYes	First EucharistNo
Confirmation	ConfirmationYes	ConfirmationNo

Child 3 Legal Name Child 3 Legal Name First Last
Child 3 Name (what they prefer to be called) Child 3 Name (what they prefer to be called) First Last
Child 3 age
Child 3 date of birth Child 3 date of birth / MM / DD YYYY
Child 3 Gender

Child 3 Gender Male Female
Child 3 School
Grade Child 3 will ENTER Fall of 2019.
Has Child 3 been Baptized

Has Child 3 been Baptized Yes No
Date and Location Child 3 was Baptized
Do You Need Assistance in Arranging Child 3's Baptism?

Do You Need Assistance in Arranging Child 3's Baptism? Yes No

Child 3 Has Received the Following Sacraments?
	Yes	No
First Reconciliation	First ReconciliationYes	First ReconciliationNo
First Eucharist	First EucharistYes	First EucharistNo
Confirmation	ConfirmationYes	ConfirmationNo

Child 4 Legal Name Child 4 Legal Name First Last
Child 4 Name (what they prefer to be called) Child 4 Name (what they prefer to be called) First Last
Child 4 age
Child 4 date of birth Child 4 date of birth / MM / DD YYYY
Child 4 Gender

Child 4 Gender Male Female
Child 4 School
Grade Child 4 will ENTER Fall of 2019.
Has Child 4 been Baptized

Has Child 4 been Baptized Yes No
Date and Location Child 4 was Baptized
Do You Need Assistance in Arranging Child 4's Baptism?

Do You Need Assistance in Arranging Child 4's Baptism? Yes No

Child 4 Has Received the Following Sacraments?
	Yes	No
First Reconciliation	First ReconciliationYes	First ReconciliationNo
First Eucharist	First EucharistYes	First EucharistNo
Confirmation	ConfirmationYes	ConfirmationNo

Child 5 Legal Name Child 5 Legal Name First Last
Child 5 Name (what they prefer to be called) Child 5 Name (what they prefer to be called) First Last
Child 5 age
Child 5 date of birth Child 5 date of birth / MM / DD YYYY
Child 5 Gender

Child 5 Gender Male Female
Child 5 School
Grade Child 5 will ENTER Fall of 2019.
Has Child 5 been Baptized

Has Child 5 been Baptized Yes No
Date and Location Child 5 was Baptized
Do You Need Assistance in Arranging Child 5's Baptism?

Do You Need Assistance in Arranging Child 5's Baptism? Yes No

Child 5 Has Received the Following Sacraments?
	Yes	No
First Reconciliation	First ReconciliationYes	First ReconciliationNo
First Eucharist	First EucharistYes	First EucharistNo
Confirmation	ConfirmationYes	ConfirmationNo

Child 6 Legal Name Child 6 Legal Name First Last
Child 6 Name (what they prefer to be called) Child 6 Name (what they prefer to be called) First Last
Child 6 age
Child 6 date of birth Child 6 date of birth / MM / DD YYYY
Child 6 Gender

Child 6 Gender Male Female
Child 6 School
Grade Child 6 will ENTER Fall of 2019.
Has Child 6 been Baptized

Has Child 6 been Baptized Yes No
Date and Location Child 6 was Baptized
Do You Need Assistance in Arranging Child 6's Baptism?

Do You Need Assistance in Arranging Child 6's Baptism? Yes No

Child 6 Has Received the Following Sacraments?
	Yes	No
First Reconciliation	First ReconciliationYes	First ReconciliationNo
First Eucharist	First EucharistYes	First EucharistNo
Confirmation	ConfirmationYes	ConfirmationNo

Do any of your children have allergies?

Do any of your children have allergies? yes no
Please list the name(s), the allergies, and reaction.
Do you have a child with special needs?

Do you have a child with special needs? yes no
Please list the name(s) and what special assistance is needed.
SPECIAL NOTES:
1. St. Stephen Parish Religious Education Programs Must Have WRITTEN Parents' Emergency Information and Legal Permission to Act in the Event of an Emergency.

2. St. Stephen PREP/EDGE Must Have Parents' Permission to Present Diocesan-Required Safe Environment Program Materials.

3. St. Stephen PREP/EDGE Requires Parents to Pledge that they Will Make Every Effort to Ensure that Their Students will Attend PREP/EDGE Regularly and Consistently

4. St. Stephen PREP/EDGE Must HAVE PARENTS' PERMISSION TO USE STUDENT'S IMAGE for Parish App / Website Purposes

INSTRUCTIONS:
1. OBTAIN EMERGENCY INFORMATION and LEGAL PERMISSION to ACT in the EVENT of an EMERGENCY / PERMISSION TO PRESENT DIOCESAN SAGE ENVIRONMENT PROGRAM/ PERMISSION TO USE IMAGE / form from Literature Rack in Church Narthex, Parish Office, of by Email from Gregory Karn ( gkarn@ssccohtn.org )
2. SIGN THE PERMISSION FORM, AND RETURN IT, SEPARATELY TO GREGORY KARN, ST. STEPHEN PARISH RELIGIOUS EDUCATION PROGRAMS DIRECTOR.

FORM CAN BE RETURNED BY:
1. SCANNING/EMAILING TO GREGORY KARN ( gkarn@ssccohtn.org )
2. MAILING TO PARISH OFFICE
3. PLACING IN WEEKLY COLLECTION BASKET
4. RETURNING TO RELIGIOUS EDUCATION OFFICE