Catechesis of the Good Shepherd School

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Please register in the Parish before submitting this form.
Family Last Name As Registered in the Parish*
Father's Name*
Mother's Name*
Mother's Maiden Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Please complete the following for each child entering the St. Nicholas PSR Program.
A copy of his/her baptismal certificate must accompany this registration form to be enrolled in a class. Registration in the parish is a prerequisite.
1. Child's Name
First Middle Last
M/F
Date of Birth
Date Format: MM slash DD slash YYYY
Grade in School
Name of School
2. Child's Name
First Middle Last
M/F
Date of Birth
Date Format: MM slash DD slash YYYY
Grade in School
Name of School
3. Child's Name
First Middle Last
M/F
Date of Birth
Date Format: MM slash DD slash YYYY
Grade in School
Name of School
Do any of your children have allergies, an IEP or 504, other? If yes, please explain:
Emergency Contact Name
First Last
Emergency Contact Phone Number

Please complete the following for each child entering the St. Nicholas PSR Program.