OUR LADY OF THE BLESSED SACRAMENT RELIGIOUS EDUCATION
P.O. BOX 489, WESTFIELD, MA 01086
REGISTRATION 2016 – 2017
$45 per child for students who are not in Sacramental years.
$75 for students in First Eucharist (2nd grade)
$75 for Confirmation students
** Online payment available for additional fee at https://www.eventbrite.com/e/religious-education-registration-for-2016-2017-year-tickets-24472291282
( Please print clearly)
STUDENT’S FIRST NAME ______MIDDLE:______LAST: ______
STUDENT’S ADDRESS: ______HOME PHONE: ______
GRADE IN SEPTEMBER ______DATE OF BIRTH ______CELL PHONE: ______CHECK TO RECEIVE
UPDATES BY TEXT MSG.
STUDENT’S EMAIL ADDRESS (Middle/High School)______
WHERE WAS CHILD BAPTIZED:______
(Church, City and State)
New students must provide a baptismal certificate, if not baptized at Our Lady of the Blessed Sacrament.
DOES YOUR CHILD HAVE ANY LEARNING NEEDS, HEALTH PROBLEMS, ALLERGIES, MEDICATIONS OR CUSTODY ISSUES
THAT WE SHOULD KNOW ABOUT? Y N
IF YES, PLEASE LIST______
FATHER’S FIRST NAME ______MIDDLE: ______LAST:______
HOME PHONE (if different): ______CELL NO. ______CHECK TO RECEIVE
UPDATES BY TEXT MSG.
FATHER’S ADDRESS (if different) ______
FATHER’S EMAIL ADDRESS ______
MOTHER’S FIRST NAME______MIDDLE:______LAST:______
MAIDEN NAME: ______HOME PHONE (if different): ______
MOTHER’S ADDRESS (if different)______CELL NO:______CHECK TO RECEIVE
UPDATES BY TEXT MSG.
MOTHER’S EMAIL ADDRESS ______
WITH WHOM DOES CHILD RESIDE? Mother ___ Father ___ BOTH ___ OTHER______
Please note any special circumstances we should know about and additional contact information we should have:
______
WE ARE REGISTERED AT - OLBS _____ OTHER ______
PARENT SIGNATURE ______
** EMERGENCY CONTACT NAME (other than parents/guardian): ______
PHONE NUMBER(S): ______RELATIONSHIP: ______
PLEASE COMPLETE REVERSE SIDE FOR ADDITIONAL CHILDREN
CAN YOU HELP WITH OUR PROGRAM?
Catechist (Teacher – grade?) ______Catechist (Aide – grade?) ______Substitute Catechist (grade?)______
Elem. Dismissal Helper _____ Weekly Office Help _____ Special projects help _____
STUDENT’S FIRST NAME ______MIDDLE:______LAST: ______
STUDENT’S ADDRESS(if different): ______HOME PHONE (if different): ______
GRADE IN SEPTEMBER______DATE OF BIRTH ______CELL PHONE: ______CHECK TO RECEIVE
UPDATES BY TEXT MSG.
STUDENT’S EMAIL ADDRESS (Middle/High School)______
WHERE WAS CHILD BAPTIZED:______
(Church, City and State)
New students must provide a baptismal certificate, if not baptized at Our Lady of the Blessed Sacrament.
DOES YOUR CHILD HAVE ANY LEARNING NEEDS, HEALTH PROBLEMS, ALLERGIES, MEDICATIONS OR CUSTODY ISSUES THAT WE SHOULD KNOW ABOUT? Y N
IF YES, PLEASE LIST______
STUDENT’S FIRST NAME ______MIDDLE:______LAST: ______
STUDENT’S ADDRESS(if different): ______HOME PHONE (if different): ______
GRADE IN SEPTEMBER______DATE OF BIRTH ______CELL PHONE: ______CHECK TO RECEIVE
UPDATES BY TEXT MSG.
STUDENT’S EMAIL ADDRESS (Middle/High School)______
WHERE WAS CHILD BAPTIZED:______
(Church, City and State)
New students must provide a baptismal certificate, if not baptized at Our Lady of the Blessed Sacrament.
DOES YOUR CHILD HAVE ANY LEARNING NEEDS, HEALTH PROBLEMS, ALLERGIES, MEDICATIONS OR CUSTODY ISSUES THAT WE SHOULD KNOW ABOUT? Y N
IF YES, PLEASE LIST______
STUDENT’S FIRST NAME ______MIDDLE:______LAST: ______
STUDENT’S ADDRESS(if different): ______HOME PHONE (if different): ______
GRADE IN SEPTEMBER______DATE OF BIRTH ______CELL PHONE: ______CHECK TO RECEIVE
UPDATES BY TEXT MSG.
STUDENT’S EMAIL ADDRESS (Middle/High School)______
WHERE WAS CHILD BAPTIZED:______
(Church, City and State)
New students must provide a baptismal certificate, if not baptized at Our Lady of the Blessed Sacrament.
DOES YOUR CHILD HAVE ANY LEARNING NEEDS, HEALTH PROBLEMS, ALLERGIES, MEDICATIONS OR CUSTODY ISSUES THAT WE SHOULD KNOW ABOUT? Y N
IF YES, PLEASE LIST______