Saint Luke Church

     Westport, Connecticut

    REGISTRATION 2017-2018

 

Questions/Comments
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You may use your "TAB" key to navigate through the form...

Please help us by filling out as much of the form as applicable to you...

 

FAMILY NAME:

HOME PHONE:

 

 

STREET: 

TOWN: 

ZIP: 

E-MAIL: 

REGISTERED  
IN THE PARISH?

4-digit PARISH ID ("Envelope") NUMBER:

NEW TO OUR  PROGRAM?

  YES  No  
  
Don't know

 
 

  YES  No

FATHER

MOTHER

LEGAL GUARDIAN / EMERGENCY CONTACT

Last
First

Religion

Street

Town

ZIP

 e-mail

Father's Cellphone

xxxxWorkPhonex

 

Last

First

Maiden

 Religion

Street

Town

ZIP

Mother's e-mail

Cellphone

xxxxxxxWorkPhone

 

Last Name
 First Name

Relationship

Street

Town

ZIP

e-mail

Home Phone

Cellphone

WorkPhonexxxxx

 PARENTS' MARITAL STATUS:    

 

TUITION DISCOUNT OPPORTUNITY:  
Will either parent serve as a Catechist (75% off) or aide (25% off ) this year?  (Credit/refund will be given at the end of the year)

CATECHIST   Aide (Office or Classroom)

No, thank you
 

STUDENT 1 STUDENT 2 STUDENT 3
Student LAST Name
Student First Name:
Student Middle Name:

 

Male     Female

Date of Birth:

 (mm/dd/yyyy)
Custodial Parent
(if applicable):
Father   Mother    n/a
Child lives with:
ALLERGIES   No
 
YES  
 
SPECIAL NEEDS   No
 
YES

If yes, please fill out the form available on the Religious Formation page

MISSED ANY YEARS OF RELIGIOUS ED? 

  No
  YES
-- Grades:  

Baptized? YES  No
Date:   (mm/dd/yyyy)
Church of Baptism:
Town, State:

Is Student currently Catholic?

YES  No

 Received
First Reconciliation?

YES  No  
No, Receiving This Year
First Reconciliation Date:   (mm/dd/yyyy)
Received
First Eucharist?
YES  No
No, Receiving This Year
First Eucharist Date:   (mm/dd/yyyy)
Received Confirmation? YES  No
No, Receiving This Year

  Confirmation Date:

  (mm/dd/yyyy)

Day & Time Preference

SEE CHART BELOW

School &
Grade in
 September 2017:


FIRST CHOICE
SECOND CHOICE

 

Student LAST Name
Student First Name:
Student Middle Name:

 

Male     Female

Date of Birth:

 (mm/dd/yyyy)
Custodial Parent
(if applicable):
Father   Mother    n/a
Child lives with:
ALLERGIES   No
 
YES  
 
SPECIAL NEEDS   No 
  YES  

If yes, please fill out the form available on the Religious Formation page

MISSED ANY YEARS OF
 RELIGIOUS ED?

  No
  YES -- Grades:

Baptized? YES  No
Date:   (mm/dd/yyyy)
Church of Baptism:
Town, State:

Is Student currently Catholic?

YES  No

 Received
First Reconciliation?

YES  No
No, Receiving This Year
First Reconciliation Date:   (mm/dd/yyyy)
Received
First Eucharist?
YES  No
No, Receiving This Year
First Eucharist Date:   (mm/dd/yyyy)
Received Confirmation? YES  No
No, Receiving This Year

  Confirmation Date:

  (mm/dd/yyyy)

Day & Time Preference

SEE CHART BELOW

School &
Grade in
 September 2017:


FIRST CHOICE
SECOND CHOICE

 

Student LAST Name
Student First Name::
Student Middle Name:

 

Male     Female

Date of Birth:

 (mm/dd/yyyy)
Custodial Parent
(if applicable):
Father   Mother   n/a
Child lives with:
ALLERGIES   No
 
YES  
 
SPECIAL NEEDS   No
 
YES  

If yes, please fill out the form available on the Religious Formation page

MISSED ANY YEARS OF
 RELIGIOUS ED?

  No
  YES -- Grades:
Baptized? YES  No
Date:   (mm/dd/yyyy)
Church of Baptism:
Town, State:

Is Student currently Catholic?

YES  No

 Received
First Reconciliation?

YES  No
No, Receiving This Year
First Reconciliation Date:   (mm/dd/yyyy)
Received
First Eucharist?
YES  No
No, Receiving This Year
First Eucharist Date:   (mm/dd/yyyy)
Received Confirmation? YES  No
No, Receiving This Year

  Confirmation Date:

  (mm/dd/yyyy)

Day & Time Preference

SEE CHART BELOW

School &
Grade in
 September 2017:


FIRST CHOICE
SECOND CHOICE

 

 

If you are registering another child, press your TAB key to go to the top of Column 2

 

If you are done, please go to the "Parental Covenant" section below.

 

 

If you are registering another child, press your TAB key to go to the top of Column 3

 

If you are done, please go to the "Parental Covenant" section below.

 

If you are done, please go to the "Parental Covenant" section below.

 

  PARENTAL COVENANT  —  Please acknowledge the following by initialing the boxes in the first column...

I understand that regular attendance at class is expected and that it is my child’s responsibility to complete all assigned readings and homework should he/she be absent.

I further understand if my child misses class more than three (3) consecutive times, he/she will be asked to come to the Religious Education Office for make up materials.
I understand that continued disruptive behavior during class will result in a parent having to attend class with their child.
  When finished, please click the "SUBMIT" button below, or click "RESET" to clear the form and start over.