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PSR Registration

The PSR year will be Wednesday, September 7, 2022 – Wednesday, May 17, 2023. Meeting times are 6:30 pm – 7:45 pm for Grades 1 – 8. Please note that we will be following all classroom guidelines from the CDC to ensure the safety of students and staff. We appreciate your flexibility and understanding if procedures need to change throughout the year. We are looking forward to seeing everyone!

2022-2023 Tuition

1 child = $225
2 children = $275
3 children = $325
4 children = $375

Tuition and all fees are due at the time of online registration. REGISTRATION IS NOT COMPLETE AND WILL NOT BE COUNTED UNTIL FULL PAYMENT HAS BEEN MADE.

Additional Material Fees by Grade Level (Due at time of registration)
2nd Grade: $30 For additional content and preparation activities.
3rd Grade: $30 For age-appropriate youth Bibles. To be used through 5th grade.
6th Grade: $30 For age-appropriate youth Bibles. To be used through 8th grade.
8th Grade: $30 For additional content and preparation activities.

Family Name *

Street *
Apt, floor, suite, etc.

City *
State *
Zip *

Parish *

If your home parish is not Annunciation, you need to obtain ANNUAL 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 *

Witness Statement

I have read the Witness Statement and I commit myself to be the first and best teacher of my children in their faith. *

INFORMATION FOR STUDENT 1

Student First Name *
Middle Initial *
Last Name *
Goes By

Date of Birth *
Gender *

School Attending *
Grade Level 2022-2023 *

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 (Individualized Education Program)? *

Does child have allergies we need to be aware of?

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

Student First Name
Middle Initial
Last Name
Goes By

Date of Birth
Gender

School Attending
Grade Level 2022-2023

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 (Individualized Education Program)?

Does child have allergies we need to be aware of?

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

Student First Name
Middle Initial
Last Name
Goes By

Date of Birth
Gender

School Attending
Grade Level 2022-2023

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 (Individualized Education Program)?

Does child have allergies we need to be aware of?

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

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

Living or Deceased? *
Marital Status
Mother's Religion *

Stepfather's First Name

Stepfather's Last Name

Father

Father's First Name *
Father's Last Name *

Living or Deceased? *
Marital Status
Father's Religion *

Stepmother's First Name
Stepmother's Last Name

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).

These e-mail addresses will be added to Flocknotes (PSR Group) so that you will receive weekly communications regarding PSR activities.

If you would also like to receive Flocknotes Text messages from PSR, please enter the phone number here:
Flocknotes Text Messages Phone

Primary Phone *

Belongs To *

Type of Phone *

Primary E-mail *

Seconday Phone
Belongs To

Type of Phone

Secondary E-mail

EMERGENCY CONTACT INFORMATION

If we cannot reach the primary/secondary phone:

Emergency Contact Name *

Emergency Contact Phone *
Relationship to Child/ren *

DISMISSAL

Information regarding our Sign Out Policy.

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

For marketing and publicity purposes, there may be times when Annunciation PSR 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 website, social media, Shutterfly Share Site (password protected).
Parish Bulletin *
Parish Website *
Social Media *

PSR Newsletter *
Shutterfly Share Site (password protected) *

ARCHDIOCESE MEDIA 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, archstl.org, St. Louis Review, Catholic St. Louis magazine, archdiocesan social media, and any publications (s) by agencies administered by the Archdiocese of St. Louis.
Archdiocese of St. Louis *

I grant permission to use my or my child/ren's image, name, recording, or academic work in websites, videos, and publications created by independent foundations and corporations that support Catholic education but are not legally connected to the Archdiocese of St. Louis, including, but not limited to, Today and Tomorrow Educational Foundation, Roman Catholic Foundation of Eastern Missouri, Access Academics, English Tutoring Project, and United Way.
Sponsoring organizations *

I grant permission to use my or my child/ren's image, name, recording, or academic work in secular media communications including, but not limited to, print, radio, TV and internet (Examples: St. Louis Post-Dispatch, KMOX radio, and KSDK-TV).
Secular media outlets *

Current month ye@r (4 digits) day *