PSR Online Registration (New Students)

Child's Full Name Please enter valid data.

Date of Birth Please enter valid data.

Gender Male Female

Mailing Address Please enter valid data.

Street Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Phone Number Please enter a phone number.

Current School Please enter valid data.

Grade Please enter valid data.

Resides With Please enter valid data.

Relationship Please enter valid data.

Father's Full Name Please enter valid data.

Father's Home Address (If Different) Please enter valid data.

Father's Phone Number (If Different) Please enter valid data.

Mother's Full Maiden Name Please enter valid data.

Mother's Home Address (If Different) Please enter valid data.

Mother's Phone Number (If Different) Please enter valid data.

Email Please enter an email address.

Sacraments Received Baptism Penance First Communion

Church of Baptism Please enter valid data.

City & State of Baptism Please enter valid data.

Date of Baptism Please enter valid data.

Date of Penance Please enter valid data.

Date of First Communion Please enter valid data.

Emergency Contacts (2 Required)

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

Child's Medical Information

Parent Electronic Signature

Acknowledgement I acknowledge that my child is free of any contagious conditions, is in good physical health, and is able to participate in regular activities.
Authorization I authorize the PSR staff to: 1) Care for my child during the time he/she is under their supervision at school. 2) Secure emergency medical care in the event that I cannot be reached.
Agreement I understand that checking this box constitutes a legal signature confirming that I acknowledge and authorize the above.

Sts. Peter & Paul Catholic Church