Re-Registration 2022-2023

Please complete ONE below form per family!

Welcome back to PSR!

 

PSR will be held for Grades K-4 on Sundays starting September 11, 2022 from 10:45 am to 12noon in the Parish Center. 

 

Grades 5-8 will be on Wednesdays starting September 7, 2022 from 6:30pm to 7:45pm in the Parish Center.

 

Confirmation will be on scheduled Sundays 10:30am to 11:45am in the Parish Center. Mass at noon See "Confirmation" page for schedule.

 

 

Information
Family Name
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Phone --
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Address
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Child Resides With
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Additional Information
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Please list other information: (new baby, adoption, separation, divorce, new marriage, serious illness, etc.)
Emergency Contact
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Emergency Contact Phone -- ext
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Please select one
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Additional Information
Phone --
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E-mail
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To be used for emailing PSR schedule changes and updates.
Choose one or more
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1. Child's Name
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Please complete an entry per child returning for their 2022-2023 PSR school year.
Date of Birth //
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School & Grade 2022-23
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PSR Grade 2022-23
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2. Child's Name
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Date of Birth //
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School & Grade 2022-2023
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PSR Grade 2022-2023
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3. Child's Name
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Date of Birth //
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School & Grade 2022-2023
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PSR Grade 2022-2023
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4. Child's Name
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Date of Birth //
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School & Grade 2022-2023
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PSR Grade 2022-2023
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Medical Emergency Form
Allergies
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If yes, please list what they are
Medications
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Learning Disabilities
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Fears
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Rates
The rates for 2022-2023 PSR school year; $50 first child, $75 two children, $100 for three or more children. Please call the Parish Office (440-428-5164) if financial assistance is needed.
Photo Release
I (We) the parent(s) and/or guardian(s)hereby grant consent for Immaculate Conception Church (“Parish”), and/or its agents to record (in writing or otherwise), photograph, audiotape, or videotape my minor child’s name, image, likeness, spoken words, student work, and/or performance, in any form, and to display, release, exhibit, publish, or distribute the same, or any part thereof, for the purpose of and in connection with any material that may be created by or on behalf of the Parish including, without limitation, Parish bulletin boards; the Parish’s weekly bulletin; the Parish’s website; print and electronic media; Parish marketing, public relations and communications materials and/or presentations; and such other uses as may not be contemplated herein, without further notice or compensation as follows: I further understand that by entering into this informed consent and release, and by granting permission as stated herein, I hereby release Immaculate Conception, Madison, the Diocese of Cleveland, and their respective officers, directors, agents and/or employees from and against any and all liability, loss, damage, costs, claims, and/or causes of action arising out of or related to the above items to which I have consented. I further understand that the Parish and its respective officers, directors, agents and/or employees have no control over use of photographs, videotapes, audiotapes, or other records made by others and/or outside the scope of this consent and release. Finally, in signing below I acknowledge that all recordings, audiotape, videotape, photographic proofs, photographic negatives, positives, and prints shall constitute the property of the Parish.
Permission Options
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Parent's Signature
Parent or Guardian Signature
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Please enter your first and last name as your electronic signature.
Spam Capture
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