PSR Registration Form 2017-2018/Catholic Community of Meridian/Meridian, MS

Please complete the registration form for each child attending PSR this year.

PARENT INFORMATION

Father REQUIRED Please fill out this field. Please enter valid data.
Cell Phone REQUIRED Please fill out this field. Please enter valid data.
Religion of Father Please enter valid data.
Mother REQUIRED Please fill out this field. Please enter valid data.
Cell Phone REQUIRED Please fill out this field. Please enter valid data.
Religion of Mother Please enter valid data.
Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Email is one of the important means of communication. Please provide a reliable address.
Email Please enter an email address.
Primary Phone Number REQUIRED Please fill out this field. Please enter valid data.

STUDENT INFORMATION

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Gender REQUIRED Please fill out this field.
Grade 2017-18 REQUIRED Please fill out this field. Please enter valid data.
School REQUIRED Please fill out this field. Please enter valid data.
Birth Date REQUIRED Please fill out this field. Please enter valid data.
Sacraments Student Has Received Baptism Reconciliation Eucharist Confirmation

STUDENT INFORMATION

First Name Please enter valid data.

Last Name Please enter valid data.
Gender
Grade 2017-18 Please enter valid data.
School Please enter valid data.
Birth Date Please enter valid data.
Sacraments Student Has Received Baptism Reconciliation Eucharist Confirmation

STUDENT INFORMATION

First Name Please enter valid data.

Last Name Please enter valid data.
Gender
Grade 2017-18 Please enter valid data.
School Please enter valid data.
Birth Date Please enter valid data.
Sacraments Student Has Received Baptism Reconciliation Eucharist Confirmation

EMERGENCY CONTACT - If parent/guardian cannot be reached.

Name REQUIRED Please fill out this field. Please enter valid data.
Relationship Please enter valid data.
Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Photo and Video Release

As a parent/guardian, I understand that my child may be filmed or photographed (individual and group) during this event. I give permission for my child’s image to be used for promotional materials (power point presentations, website, newsletter, etc.) to highlight this event. No names will be used, only photos and videos.
Photo and Video Release REQUIRED Please fill out this field.

By submitting this online form, I agree that all the included information is accurate to the best of my knowledge. I understand that a copy of my child's sacramental certificates is needed to complete my child's registration.

I Agree Please select this field.