PSR/CCD Registration (2023-2024)

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St. Joseph the Worker Parish 229 California Ave. Weirton, WV 26062 Tel#: 304-723-2054 Email: joetheworkerdre@gmail.com

Email *

Child's First & Last Name *

Date of Birth *

YYYY

Age *

Upcoming Grade Level (i.e., 1st, 2nd, etc.) *

Student's Current Home Address *

Allergies/Medical Conditions *

Mother's Name (First, Middle, Last) *

Mother's Maiden Name *

Mother's Cell Phone #, Email Address, & Mailing Address (if different from above, otherwise, enter "same as the above") *

Father's Full Name *

Father's Cell Phone #, Email Address, & Mailing Address (if different from above, otherwise, enter "same as the above") *

Who does the child live with? *

Both Parents

Mother Only

Father Only

Other (please explain below)

If "Other," please explain, otherwise, enter "N/A" (not applicable) *

If student lives with one parent, please indicate who has legal custody and/or if child also lives with stepparent. Otherwise, enter "N/A." *

Does this student have any medical or learning disabilities or food allergies? *

Is there anyone your child should not be picked up by? *

Yes

If "Yes" - by whom? If "No" - type N/A *

Name of Primary Contact (Parent/Legal Guardian) *

Primary Contact's Relation to Student *

Primary Contact's Cell Phone #, Email Address, & Mailing address *

Secondary Contact's Name, Relation to student, Phone Number, & Email (Optional)

Is child baptized? (If this student is being registered for the first time, please provide a Baptism certificate to the parish office) *

Yes

If yes, date of baptism

YYYY

Church where child was baptized (include city & state). *

Please check the other sacraments the student has received *

1st Reconciliation (Confession)

First Holy Communion (FHC)

Confirmation

None of the above

Required

Please indicate which of the choices below most accurately reflects your current faith practice as a family *

Not currently attending Sunday (or Saturday evening) Mass and Confession as a family with any regularity.

Seeking as a family to begin a more fruitful practice of our faith for the first time.

Seeking as a family to return to a more faithful practice of our faith after some time away.

Currently attending Sunday (or Saturday evening) Mass fairly often, and Confession less often than yearly.

Currently attending Sunday (or Saturday evening) Mass most weeks, and Confession at least once a year.

Currently attending Sunday (or Saturday evening) Mass as family every week, and Confession more than once a year.

Required

Registration Fee ($35.00) - This helps cover the cost for texts, materials, food, etc. This year, each student will receive a print copy of their respective Word of Life Book in addition to gaining access to the WOL Portal (Please drop off all cash and check payments to the Parish Office) *

Cash

Check - Make check payable to St. Joseph the Worker Catholic Church)

Venmo @stjosephtheworkerdre

Checklist

Registration

Baptism Certificate (if student is being registered for the first time, submit to the Parish Office or email a copy of it to Mark at joetheworkerdre@gmail.com)

Registration Fee ($35.00)

Liability Waiver

Photo Release Form

Touching Safety Opt-out Letter

Liability/Hold Harmless Waiver

By entering my digital signature below (Parent's First and Last name), I agree to the conditions as outlined in the above Liability Waiver/Hold Harmless & Code of Conduct Forms. *

Photo Release Permission *

I grant the permission outlined in the above Photo Release Form

I refuse the permission outlined in the above Photo Release Form

Touching Safety Opt-out Letter

By entering my digital signature below (Parent's First and Last name), I acknowledge that St. Joseph the Worker PSR/CCD program DOES NOT have my permission to present the Touching Safety program to my child. Furthermore, I am aware that I have the option of presenting the materials to my child if I so choose. To sign, enter you child's first and last name and a hyphen (-) after it. Afterward, enter the signing parent's first and last name on the same line and today's date i.e. Joe Smith Jr. - Mary Smith 08/16/2023) *

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