2022-23 New Student Registration Form 2022-2023 Registration for New Students / Families Registration for New Students / Families Step 1 of 9 11% To Switch to Spanish: Select Spanish in the Drop Down Menu in Upper Right Corner of the Website. Welcome! We are glad to have you in our religious education program! Today's Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Family Home InformationFamily Last Name* Home Address (where student(s) reside)* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Telephone Number*Primary E-mail Address*Information throughout the year will be sent to you by e-mail. Please be sure your e-mail is correct. Thank you. Language(s) Spoken at Home?* English Spanish English & Spanish Other Is the Family Registered at Saint Andrew?* Yes No Family's Envelope Number / Faith Direct? Is the family currently attending Sunday Mass?* Yes No Is the family registered at another church?* Yes No What is the name of the church? New Student(s) InformationHow many children will you be registering in Religious Education for 2022-2023?*NOTE: If you need to register 5 or more children in our religious education program, please do not complete this form online and contact the Religious Education coordinator. 1234 Student 1Name of Child* First Middle Last Child's Date of Birth* Month Day Year Place of Birth*(City, State, & Country) Age of Child*5 Years6 Years7 Years8 Years9 Years10 Years11 Years12 Years13 Years14 Years15 Years16 Years17 Years18 Years19 YearsGender* Male Female What is the name of the child's school for 2022-2023?* Please select the grade level your child is entering in Fall 2022.*Kindergarten1st2nd3rd4th5th6th7th8th9th10th11th12thDoes the child have any allergies? (Plants, Food, Insects, Medicine)* Yes No Please list/explain the child's allergies.If applicable, please explain any physical limitation/disability or learning disability the student has.Sacrament InformationWas the child baptized?* Yes No Is the church of Baptism Catholic?* Yes No Not Applicable Year of Baptism Church of Baptism City and State / Country of Baptism Did the child receive First Communion?* Yes No Did the child receive Confirmation?* Yes No If applicable, please upload child's Baptismal, First Communion, and Confirmation certificates.NOTE: The file(s) must be in .pdf or .jpg, or .png format. However, you are NOT required to submit any of the certificate/s electronically. You may submit the certificate/s later to the Religious Education office. Thank you! Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 2 MB, Max. files: 3. Class Sessions Session 1 Tuesday Afternoon 4:30 PM - 5:45 PM (1,2,3,4,5) Communion I and II Elementary Session 2 Tuesday Evening 6:30 PM - 7:45 PM MS (6,7,8) and HS (9,10,11,12) Confirmation I and II Session 3 Saturday Morning 9:15 AM - 10:30 AM Elementary, Communion I and II (K,1,2,3,4,5) MS (6,7,8) Confirmation I and II MS First Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday MorningSecond Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday MorningThird Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday Morning Student 2Name of Child* First Middle Last Child's Date of Birth* Month Day Year Place of Birth*(City, State, & Country) Age of Child*5 Years6 Years7 Years8 Years9 Years10 Years11 Years12 Years13 Years14 Years15 Years16 Years17 Years18 Years19 YearsGender* Male Female What is the name of the child's school for 2022-2023?* Please select the grade level your child is entering in Fall 2022.*Kindergarten1st2nd3rd4th5th6th7th8th9th10th11th12thDoes the child have any allergies? (Plants, Food, Insects, Medicine)* Yes No Please list/explain the child's allergies.If applicable, please explain any physical limitation/disability or learning disability the student has.Sacrament InformationWas the child baptized?* Yes No Is the church of Baptism Catholic?* Yes No Not Applicable Year of Baptism Church of Baptism City and State / Country of Baptism Did the child receive First Communion?* Yes No Did the child receive Confirmation?* Yes No If applicable, please upload child's Baptismal, First Communion, and Confirmation certificates.NOTE: The file(s) must be in .pdf or .jpg, or .png format. However, you are NOT required to submit any of the certificate/s electronically. You may submit the certificate/s later to the Religious Education office. Thank you! Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 2 MB, Max. files: 3. Class Sessions Session 1 Tuesday Afternoon 4:30 PM - 5:45 PM (1,2,3,4,5) Communion I and II Elementary Session 2 Tuesday Evening 6:30 PM - 7:45 PM MS (6,7,8) and HS (9,10,11,12) Confirmation I and II Session 3 Saturday Morning 9:15 AM - 10:30 AM Elementary, Communion I and II (K,1,2,3,4,5) MS (6,7,8) Confirmation I and II MS First Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday MorningSecond Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday MorningThird Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday Morning Student 3Name of Child* First Middle Last Child's Date of Birth* Month Day Year Place of Birth*(City, State, & Country) Age of Child*5 Years6 Years7 Years8 Years9 Years10 Years11 Years12 Years13 Years14 Years15 Years16 Years17 Years18 Years19 YearsGender* Male Female What is the name of the child's school for 2022-2023?* Please select the grade level your child is entering in Fall 2022.*Kindergarten1st2nd3rd4th5th6th7th8th9th10th11th12thDoes the child have any allergies? (Plants, Food, Insects, Medicine)* Yes No Please list/explain the child's allergies.If applicable, please explain any physical limitation/disability or learning disability the student has.Sacrament InformationWas the child baptized?* Yes No Is the church of Baptism Catholic?* Yes No Not Applicable Year of Baptism Church of Baptism City and State / Country of Baptism Did the child receive First Communion?* Yes No Did the child receive Confirmation?* Yes No If applicable, please upload child's Baptismal, First Communion, and Confirmation certificates.NOTE: The file(s) must be in .pdf or .jpg, or .png format. However, you are NOT required to submit any of the certificate/s electronically. You may submit the certificate/s later to the Religious Education office. Thank you! Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 2 MB, Max. files: 3. Class Sessions Session 1 Tuesday Afternoon 4:30 PM - 5:45 PM (1,2,3,4,5) Communion I and II Elementary Session 2 Tuesday Evening 6:30 PM - 7:45 PM MS (6,7,8) and HS (9,10,11,12) Confirmation I and II Session 3 Saturday Morning 9:15 AM - 10:30 AM Elementary, Communion I and II (K,1,2,3,4,5) MS (6,7,8) Confirmation I and II MS First Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday MorningSecond Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday MorningThird Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday Morning Student 4Name of Child* First Middle Last Child's Date of Birth* Month Day Year Place of Birth*(City, State, & Country) Age of Child*5 Years6 Years7 Years8 Years9 Years10 Years11 Years12 Years13 Years14 Years15 Years16 Years17 Years18 Years19 YearsGender* Male Female What is the name of the child's school for 2022-2023?* Please select the grade level your child is entering in Fall 2022.*Kindergarten1st2nd3rd4th5th6th7th8th9th10th11th12thDoes the child have any allergies? (Plants, Food, Insects, Medicine)* Yes No Please list/explain the child's allergies.If applicable, please explain any physical limitation/disability or learning disability the student has.Sacrament InformationWas the child baptized?* Yes No Is the church of Baptism Catholic?* Yes No Not Applicable Year of Baptism Church of Baptism City and State / Country of Baptism Did the child receive First Communion?* Yes No Did the child receive Confirmation?* Yes No If applicable, please upload child's Baptismal, First Communion, and Confirmation certificates.NOTE: The file(s) must be in .pdf or .jpg, or .png format. However, you are NOT required to submit any of the certificate/s electronically. You may submit the certificate/s later to the Religious Education office. Thank you! Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 2 MB, Max. files: 3. Class Sessions Session 1 Tuesday Afternoon 4:30 PM - 5:45 PM (1,2,3,4,5) Communion I and II Elementary Session 2 Tuesday Evening 6:30 PM - 7:45 PM MS (6,7,8) and HS (9,10,11,12) Confirmation I and II Session 3 Saturday Morning 9:15 AM - 10:30 AM Elementary, Communion I and II (K,1,2,3,4,5) MS (6,7,8) Confirmation I and II MS First Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday MorningSecond Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday MorningThird Preference*Session 1:Tuesday AfternoonSession 2: Tuesday EveningSession 3: Saturday Morning Family and Parent/Guardian InformationParent(s) / Legal Guardian(s) that student(s) resides with?*Please inform the religious education office if the parent(s) marital status has changed from previous year. Mother & Father Mother Only Father Only Parent (Mother/Father) & Step-Parent Other / Legal Guardian(s) Marital Status of Student(s) Parents Single Parent (never married) Common Law (living together - not married) Married Separated Divorced Remarried Widowed (Not Remarried) Are parents married civilly or by church?* Married Civilly Married in the Catholic Church Not Applicable In the case of Single / Unmarried parents, which parent(s) have legal custody of the student(s)?* In the State of Florida an unmarried father has no legal rights to custody or timesharing until paternity is established and the name is listed on the child’s birth certificate (or other appropriate legal documentation). Unless established, the mother has sole, legal and physical custody of the child or children. Birth certificate of the child and any other supporting legal documentation must be submitted to the Religious Education office. Thank you. Mother only Father only Mother & Father Not Applicable In the case of parental divorce / separation, which parent(s) have legal custody of the child?*Documentation must be submitted to the religious education office. Mother only Father Only Mother & Father (shared custody) Not Applicable Parent/Guardian 1: Name* First Middle Last Parent/Guardian 1: Relationship to Child*MotherFatherStep-FatherStep-MotherOther / Legal GuardianParent/Guardian 1: Telephone Number*Parent/Guardian 1: E-mail Address* Parent/Guardian 1 is:* Catholic Non-Catholic Christian What is the occupation of Parent/Guardian 1?* Parent/Guardian 2: Name* First Middle Last Parent/Guardian 2: Relationship to Child*MotherFatherStep-FatherStep-MotherOther / Legal GuardianParent/Guardian 2: Telephone Number*Parent/Guardian 2: E-mail Address* Parent/Guardian 2 is:* Catholic Non-Catholic Christian What is the occupation of Parent/Guardian 2?* Parent/Guardian 2: Name First Middle Last Parent/Guardian 2: Relationship to ChildMotherFatherStep-FatherStep-MotherOther / Legal GuardianParent/Guardian 2: Telephone NumberParent/Guardian 2: E-mail Address: Parent/Guardian 2 is... Catholic Non-Catholic Christian What is the occupation of Parent/Guardian 2? Emergency Contact InformationIn the event of an emergency and we are unable to reach you, please give us the name and contact information of someone to contact that is NOT the child's parent/guardian. This person must have your permission to pick-up your child if necessary.Emergency Contact: Name* First Name Last Name Emergency Contact: Telephone Number*What is his/her relationship to the child(ren)?*(Emergency contact's relationship to child/ren) Permission to Pick-Up ChildPlease list any additional individual(s) other than parent/guardian with permission to pick up child(ren). Additional Contact 1 Name First Last Additional Contact 1: Telephone NumberAdditional Contact 2: Name First Name Last Name Additional Contact 2: Telephone NumberIf applicable, please provide us the name of any individual(s) that is NOT permitted to pick-up child(ren).Does your child(ren) have permission to walk home? (Middle & High School Students Only)* Yes No Not Applicable Parent Volunteer OpportunitiesYour contribution of time and talent is crucial to the success of our program. Opportunities for your involvement are listed below. All volunteers make a difference for our kids. Help make a difference in your child's religious education! Please check which options you are interested in! RE Catechist RE Catechist Aide RE Entrance Monitor RE Crossing Guard Office Help Special Event Help Authorization and Medical Insurance InformationPlease read the following information carefully before agreeing and giving permission below. Thank you.Permission and Release of Liability*I / We as the parent(s)/ legal guardian(s) of the child(ren) listed on this registration form give my permission for him/her to attend to Saint Andrew’s Religious Education Program year 2022-2023. In the event of an emergency, I (We), hereby give permission to transport my child to a hospital for emergency medical, dental, anesthetic or surgical treatment. I (We) wish to be advised prior to any non-emergency treatment by the hospital or doctor. I (We) agree to pay for any expenses incurred for such treatment. I (We), individually and in my(our) capacities as parent(s)/legal guardian(s) release, indemnify, and hold harmless the Archbishop of Miami, the Archdiocese of Miami or any parish thereof, its employees, agents, representatives, affiliates, and volunteers from any and all demands, claims, and liability arising out of my child's participation in the program. I (We) hereby waive my claim to a lawsuit against the Archdiocese of Miami or any such persons for any liability arising out of my child's participation in this program. I/ We freely agree and grant permission and release of liability.Medical Insurance Company Medical Insurance ID Number Medical Insurance Group Number Name of Child(ren)'s Physician* Physician's Telephone Number*USE OF PHOTOS: The Parish reserves the right to use student or parent photos in any parish publication and on the parish’s website. Any parent/guardian who does not wish his or her child’s picture or video to be used accordingly must be stated (by not giving permission/consent). Parents/Guardians, by consenting to this acknowledgement of receipt of notice, HEREBY RELEASE St. Andrew Parish, the Archdiocese of Miami, and their corporate members, officers, employees, and agents, from any claims or liabilities that allegedly arise from or are related to the use of student or parent photos.* I/We agree and give permission. I/We DO NOT agree and do not give permission. Sacramental Certificate(s) for Reception of Sacraments*I/we are aware and accept that in order to receive any of the sacraments of Initiation; I need to submit to the Parish of Saint Andrew a copy of the Baptismal Certificate, First Communion, and/or Confirmation Certificate(s) if applicable by the deadline date announced by the Coordinator. I understand that the failure to this may result in delaying the reception of the Sacraments. If the child was baptized at St. Andrew Catholic Church, the parent or legal guardian must request a copy to the parish office directly. I/We understand.Authorization as Parent(s)/Guardian(s)*I/We are the parent(s) or legal guardian(s) of the student(s) named herein and have legal authority to execute the above permissions and to affix my/our signature(s) below. I/We agree.Parent/Guardian 1 Signature*Parent/Guardian 2 Signature*Parent/Guardian 2 Signature Tuition Payment & Billing InformationPlease answer the following questions - then click submit and you will be redirected to our account to submit your payment information. You can pay by logging into your personal paypal account to pay or by selecting to pay with your credit or debit card. You do not need to create a paypal account. Payment must be submitted or your registration will not be received. Thank you and God bless!Are you a registered member of Saint Andrew?*YesNoWhat is your parish envelope number? Tuition*I/We authorize the religious education office to verify our parish affiliation and if applicable adjust tuition accordingly. I/We understand.Tuition*Tuition for 2022-2023 is $130 for registered parishioners and $250 for non-registered parishioners. Tuition includes a $50 registration fee. If you are in need of financial assistance or a payment plan, please contact Beatriz Castro at bcastro@sacccs.org or by calling 954-905-6322. Note: Parish affiliation will be verified and tuition will be adjusted accordingly. New Student/Family Full Tuition & Registration Fee(Registered Parishioners) - $130 New Student/Family Full Tuition & Registration (Non-Registered Parishioners) - $250 TotalA $3 processing fee has been added. $0.00 Account Holder's Name (for payment purposes)* First Middle Last Email Address (for payment purposes)* Enter Email Confirm Email CommentsThis field is for validation purposes and should be left unchanged.