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PSR Registration 2023-24
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* Indicates required question
Family Last Name
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Your answer
Main Email Address. This will be used to send out reminders, cancellations, schedule changes, class information and other important announcements.
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Your answer
Birth Father's Name
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Your answer
Birth Father's Cell Phone
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Your answer
Birth Father's Religion
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Your answer
Is the Birth Father a Member of Saint John Vianney?
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Yes
No
Birth Mother's Name
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Your answer
Birth Mother's Maiden Name
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Your answer
Birth Mother's Cell Phone
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Your answer
Birth Mother's Religion
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Your answer
Is the Birth Mother a member of Saint John Vianney?
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Yes
No
List the full name and phone number of any other adults involved.
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Your answer
Do the children live with:
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Both parents 1 home
Only with the Father
Only with the Mother
Shared Custody both homes
Primary Address
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Your answer
Child 1 Name
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Your answer
Pick one of the following for Child 1
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In person PSR on Sunday mornings from 8:40-10:10 at Lake Catholic
Home Study PSR
Child 1 Grade in the Fall of 2023
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Your answer
Has Child 1 successfully completed previous years of PSR?
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Yes
No
Has Child 1 completed the grade level appropriate sacraments?
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Yes
No
Does Child 1 have any accommodations in school that we need to be aware of? If yes, please explain.
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Your answer
Child 2 Name
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Your answer
Pick one of the following for Child 2
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In person PSR on Sunday mornings from 8:40-10:10 at Lake Catholic
Home Study PSR
Child 2 Grade in the Fall of 2023
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Your answer
Has Child 2 successfully completed previous years of PSR?
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Yes
No
Has Child 2 completed the grade level appropriate sacraments?
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Yes
No
Does Child 2 have any accommodations in school that we need to be aware of? If yes, please explain.
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Your answer
Child 3 Name
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Your answer
Pick one of the following for Child 3
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In person PSR on Sunday mornings from 8:40-10:10 at Lake Catholic
Home Study PSR
Child 3 Grade in the Fall of 2023
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Your answer
Has Child 3 successfully completed previous years of PSR?
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Yes
No
Has Child 3 completed the grade level appropriate sacraments?
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Yes
No
Does Child 3 have any accommodations in school that we need to be aware of? If yes, please explain.
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Your answer
Child 4 Name
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Your answer
Pick one of the following for Child 4
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In person PSR on Sunday mornings from 8:40-10:10 at Lake Catholic
Home Study PSR
Child 4 Grade in the Fall of 2023
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Your answer
Has Child 4 successfully completed previous years of PSR?
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Yes
No
Has Child 4 completed the grade level appropriate sacraments?
*
Yes
No
Does Child 4 have any accommodations in school that we need to be aware of? If yes, please explain.
*
Your answer
Emergency Consent Form
Please fill out for each child.
Child 1 Name
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Your answer
Consent to call 911 in case of emergency for Child 1
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Yes
No
Allergies:
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Your answer
Child 2 Name
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Your answer
Consent to call 911 in case of emergency for Child 2
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Yes
No
Allergies:
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Your answer
Child 3 Name
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Your answer
Consent to call 911 in case of emergency for Child 3
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Yes
No
Allergies:
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Your answer
Child 4 Name
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Your answer
Consent to call 911 in case of emergency for Child 4
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Yes
No
Allergies:
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Your answer
Payment is $75 per child for both in person and home study. Kindergarten cost is $25 (click "other" button to pay this fee) Please pay that
here.
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Option 1
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