PSR Registration

2019-2020 PSR Tuition Fee:

1 child: $175

2 children: $225

3 children: $275

4 children: $325

After you complete registration, please mail or drop a check off at the rectory.

T-shirt Cost:

To foster a sense of community, we encourage all students to have a "Get Connected" t-shirt which is worn on specified PSR nights/activities. The cost for the t-shirts depends on the number of t-shirts ordered and is not included in your tuition fee (approximately $15). You will receive additional information regarding the cost/payment at a later date.

Family Name *

Street *
Apt, floor, suite, etc.

City *
State *
Zip *

Parish *

If your home parish is not Annunciation, you need to obtain authorization from your Pastor. Please print this form and provide to your Pastor. Upon completion, please mail or drop the form off at the rectory.
Number of Students Registering *
Student Lives With *

INFORMATION FOR STUDENT 1

First Name *
Middle Initial *
Last Name *

Date of Birth *
Gender *

School Attending *
Grade Level 2019-2020 *

For students entering grade 1 or new students

A copy of your baptism certificate must be requested from the parish the child was baptized and turned into rectory.

Baptism Date
Baptism Parish and Address

For new students only

First Reconciliation Date
First Reconciliation Parish

First Communion Date
First Communion Parish

For all students

What would you like us to know about your child to help PSR staff in meeting your child’s medical, emotional, spiritual, and learning needs?

Does your child have an IEP? *

Does child have allergies we need to be aware of?

T-shirt Size *

Information about Safe Touch Program

I authorize Annunciation PSR to present the Archdiocese’s Safe Touch Program to my child at age appropriate level. *

Information about God's Own Making Human Sexuality Program

For children in Grades 4-8: I authorize Annunciation PSR to present the Archdiocese’s God’s Own Making Human Sexuality Program to my child at an age appropriate level. *
INFORMATION FOR STUDENT 2

First Name
Middle Initial
Last Name

Date of Birth
Gender

School Attending
Grade Level 2019-2020

For students entering grade 1 or new students

A copy of your baptism certificate must be requested from the parish the child was baptized and turned into rectory.

Baptism Date
Baptism Parish and Address

For new students only

First Reconciliation Date
First Reconciliation Parish

First Communion Date
First Communion Parish

For all students

What would you like us to know about your child to help PSR staff in meeting your child’s medical, emotional, spiritual, and learning needs?

Does your child have an IEP?

Does child have allergies we need to be aware of?

T-shirt Size

I authorize Annunciation PSR to present the Archdiocese’s Safe Touch Program to my child at age appropriate level.

For children in Grades 4-8: I authorize Annunciation PSR to present the Archdiocese’s God’s Own Making Human Sexuality Program to my child at an age appropriate level.
INFORMATION FOR STUDENT 3

First Name
Middle Initial
Last Name

Date of Birth
Gender

School Attending
Grade Level 2019-2020

For students entering grade 1 or new students

A copy of your baptism certificate must be requested from the parish the child was baptized and turned into rectory.

Baptism Date
Baptism Parish and Address

For new students only

First Reconciliation Date
First Reconciliation Parish

First Communion Date
First Communion Parish

For all students

What would you like us to know about your child to help PSR staff in meeting your child’s medical, emotional, spiritual, and learning needs?

Does your child have an IEP?

Does child have allergies we need to be aware of?

T-shirt Size

I authorize Annunciation PSR to present the Archdiocese’s Safe Touch Program to my child at age appropriate level.

For children in Grades 4-8: I authorize Annunciation PSR to present the Archdiocese’s God’s Own Making Human Sexuality Program to my child at an age appropriate level.
PARENT INFORMATION

Mother

First Name *
Last Name *
Mother's Maiden Name
Phone

Living or Deceased? *
Marital Status *
Religion *

Father

First Name *
Last Name *

Phone

Living or Deceased? *
Marital Status *
Religion *

Stepmother

First Name
Last Name

Phone

Stepfather

First Name
Last Name

Phone

CONTACT INFORMATION

The primary is the e-mail address that we will use to send weekly updates and important information regarding PSR. It is important that this is an e-mail that is looked at daily. Secondary is optional (you can add if you would like us to communicate weekly with both parents).
Primary Phone *
Primary E-mail *
Belongs To *

Seconday Phone
Secondary E-mail
Belongs To

EMERGENCY CONTACT INFORMATION (Other than parent)

Name *

Phone *
Relationship to Child/ren *

DISMISSAL

Information regarding our Sign Out Policy.

Additional people allowed to pick-up my children (other than mother/father) *
MEDIA AUTHORIZATION

For marketing and publicity purposes, there may be times when the school/parish wishes to use your and/or your child(ren)’s image, name, recording, or academic work in various media for marketing and/or publicity purposes. Our purpose for asking is to mainly use in the bulletin and on the website. As a parent, you may grant or deny authorization.

I grant permission to use my or my child(ren)’s image, name, recording, or academic work in communications that include, but are not limited to, the parish bulletin, PSR newsletter, parish/school website, social media, Shutterfly Share Site (password protected).
Parish Bulletin *
Parish Website *
Social Media *

PSR Newsletter *
Shutterfly Share Site (password protected) *

Current month ye@r (4 digits) day *