In Person PSR Registration Form

Registration for New students and returning students
St. John Vianney Parish School of Religion (Gr. K-8)
Complete this form include each child to be registered.
An asterisk * indicates required information.
When the box turns red it is incorrectly entered
fix the entry before you continue.
Click ‘I am not a robot, complete the task
after the green check appears click Submit.

In Person PSR Fees 2022-2023:
Grades 1 – 8 • $75 per student
Kindergarten • $25 per student

Fill in the following Information for each student your are registering - Complete Baptism Info for New Students Only - Please mail or drop off a COPY of the Baptism Certificate for each New Student.

Last Name *

Student 1 (Grades K - 8)

STUDENT NAME *

First Name, Middle Name, Last Name

Grade 2022-2023 * K 1 2 3 4 5 6 7 8

Public School Student is Attending 2022-2023 *

Date of Baptism

NEW STUDENTS ONLY

Church of Baptism

NEW STUDENTS ONLY

City & State of Church of Baptism

NEW STUDENTS ONLY

SPECIAL CIRCUMSTANCES (PLEASE LIST FOR EACH CHILD)

i.e. attention deficit, learning disabled, asthma, allergies, illnesses, etc.

Student 2 (Grades K - 8)

STUDENT NAME *

First Name, Middle Name, Last Name

Grade 2022-2023 * K 1 2 3 4 5 6 7 8

Public School Student is Attending 2022-2023 *

Date of Baptism

NEW STUDENTS ONLY

Church of Baptism

NEW STUDENTS ONLY

City & State of Church of Baptism

NEW STUDENTS ONLY

SPECIAL CIRCUMSTANCES (PLEASE LIST FOR EACH CHILD)

i.e. attention deficit, learning disabled, asthma, allergies, illnesses, etc.

Student 3 (Grades K - 8)

STUDENT NAME *

First Name, Middle Name, Last Name

Grade 2022-2023 * K 1 2 3 4 5 6 7 8

Public School Student is Attending 2022-2023 *

Date of Baptism

NEW STUDENTS ONLY

Church of Baptism

NEW STUDENTS ONLY

City & State of Church of Baptism

NEW STUDENTS ONLY

SPECIAL CIRCUMSTANCES (PLEASE LIST FOR EACH CHILD)

i.e. attention deficit, learning disabled, asthma, allergies, illnesses, etc.

Student 4 (Grades K - 8)

STUDENT NAME *

First Name, Middle Name, Last Name

Grade 2022-2023 * K 1 2 3 4 5 6 7 8

Public School Student is Attending 2022-2023 *

Date of Baptism

NEW STUDENTS ONLY

Church of Baptism

NEW STUDENTS ONLY

City & State of Church of Baptism

NEW STUDENTS ONLY

SPECIAL CIRCUMSTANCES (PLEASE LIST FOR EACH CHILD)

i.e. attention deficit, learning disabled, asthma, allergies, illnesses, etc.

Student 5 (Grades K - 8)

STUDENT NAME *

First Name, Middle Name, Last Name

Grade 2022-2023 * K 1 2 3 4 5 6 7 8

Public School Student is Attending 2022-2023 *

Date of Baptism

NEW STUDENTS ONLY

Church of Baptism

NEW STUDENTS ONLY

City & State of Church of Baptism

NEW STUDENTS ONLY

SPECIAL CIRCUMSTANCES (PLEASE LIST FOR EACH CHILD)

i.e. attention deficit, learning disabled, asthma, allergies, illnesses, etc.

Family Information

Legal Birth Father's Name *

Legal Birth Mother's Full Name *

Mother's Maiden Name *

Student's Address *

Address, Street, City and Zip

Mother's Phone # *

Best Phone number to reach mother

Mother's Email address *

Mother's Religion *

Mother would you be interested in volunteering with our PSR program? Yes No

Mother

Father's Phone # *

Best Phone number to reach father

Father's Email address *

Father's Religion *

Father would you be interested in volunteering with our PSR program? Yes No

Father

Child Lives With * Both Parents (1 Home) Father Only Mother Only Shared Custody (2 Homes)

Custodial Parent (if applicable)

Are you a registered member of St. John Vianney: *

Yes

No

If no, indicate parish

We use the information provided above for our communications and records. In situations with blended families, grandparents providing PSR, and other circumstances, it is important for us to know who is involved and who needs information so that we can keep everyone well informed. Note that we can only send information to one additional address, but we can email/call others as needed.

Are there any other adults involved this year?

Yes

No

Are there any other adults PSR info should be sent to?

Yes

No

List Other Adults Involved in your children’s PSR

Name

Relationship

Involved in PSR

Yes

Send Info

Yes

Address

Address, Street, City and Zip

Phone

Email

Name

Relationship

Involved in PSR

Yes

Send Info

Yes

Address

Address, Street, City and Zip

Phone

Email

PSR Fee for your family

Select the Correct Fee based on the number of students and the grade they will be in for the 2022-2023 school year. Make a note of the amount due for your family. $75.00 - 1 Student in Gr 1-8 $150.00 - 2 Students in Gr 1-8 $225.00 - 3 Students in Gr 1-8 $300.00 - 4 Students in Gr 1-8 $25.00 - 1 Student in Kindergarten Only $100.00 - 1 Student in Gr 1-8 + 1 Kindergarten Student $150.00 - 2 Students in Gr 1-8 + 1 Kindergarten Student $250.00 - 3 Students in Gr 1-8 + 1 Kindergarten Student $325.00 - 4 Students in Gr 1-8 + 1 Kindergarten Student $50.00 - 2 Kindergarten Students Only Other

To submit this form: Check - I’m not a robot and complete the task. A green check will appear when completed correctly. Next click Submit. Wait to see the message that your responses will be sent to the SJV Faith Formation Office.

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After you successfully SUBMIT your online registration form you may pay the PSR Fees for child/children registered. Pay by cash or check or make Payment Online by clicking the Cross image below. You will be taken to PayPal where you can make payment.  If you need financial assistance with this fee, please contact the Faith Formation Office.

Calculate your family Fees for In Person PSR 2022-2023:
$75.00 – 1 Student in Gr 1-8
$150.00 – 2 Students in Gr 1-8
$225.00 – 3 Students in Gr 1-8
$300.00 – 4 Students in Gr 1-8
$25.00 – 1 Student in Kindergarten Only
$100.00 – 1 Student in Gr 1-8 + 1 Kindergarten Student
$150.00 – 2 Students in Gr 1-8 + 1 Kindergarten Student
$250.00 – 3 Students in Gr 1-8 + 1 Kindergarten Student
$325.00 – 4 Students in Gr 1-8 + 1 Kindergarten Student
$50.00 – 2 Kindergarten Students Only

On our payment page at PayPal use OTHER
if your family’s PSR fee does not match one of the
pre-set amounts.
Click the picture below to go to PayPal now.