PREP Online Registration/Payment Form 2018-2019

Complete One Registration Per Student

PREP 2018-2019

Online Registration/Payment

Welcome to the Parish Religious Education Program (PREP) at St. Bede the Venerable Roman Catholic Church. Please complete the following form to register a student(s) in the 2018-2019 school year.

Our pre-school sessions consist of a combined Pre-Kindergarten and Kindergarten classes (4 & 5 year olds). The class is on Sunday mornings during the 9am Mass. The children meet in a classroom on the 3rd floor of the Education Center.

Our elementary sessions for grades 1-6 meet on Sunday mornings as well. Families are encouraged to attend the 9:00am Mass and have their child participate in the Childrens Liturgy of the Word which is offered during the homily portion of the Mass. After Mass, the children meet in the classrooms of the Education Center from 10:15-11:30am.

In our goal to assist parents as the primary catechist of their children, we offer a home study program for grades 3-6. Home Study includes work to be done at home and turned in to our office as well as a once-a-month on-campus session. All cirriculum supplies are provided.

It is expected all families actively participate in our St. Bede weekend and Holy Day liturgies, as the Eucharist is the source and sumimit of our faith.

If your family is registered as St. Bede parishioners, the fee is $125 per student (and $90 per additional family member) which covers materials, catechist training, etc. We welcome non-parishioners as well; however, the fee for children whose families are not registered as parishioners is $175 per child. We ask all parents to volunteer five hours in the office during class time, purchase supplies or make a cash donation.

Session dates are incorporated into the public school calendars of both La Canada and Glendale Unified School Districts. A calendar will be provided in August to all registered families.

After submitting this online form to register your child in our 2018-2019 PREP classes, you may receive several other pieces of information including the Teaching Touching Safety form which needs to be signed and returned to the PREP Office and a list of supplies that are always needed in the PREP Office.

If you have any questions or concerns, feel free to contact Moira Arjani, Director of Religious Education at 818-949-4323 or by email to moira@bede.org.

Thank you and many blessings to your family.

Student to Be Registered

Name of Student

First Name*

Middle Name

Last Name*

Family Address

Street 1*

Street 2

City*

State*

Zip*

Family E-mail

Required*

Sex
Required*

Male

Female

Date of Birth

Required* //

School Attending

Required*

Grade Level Entering in the Fall
Required*

	PK-K
	1
	2
	3

	4
	5
	6

Sacraments Received
Required*

	Baptism
	First Reconciliation

	First Communion
	None

Church of Baptism

	St. Bede
	Other Catholic Parish
	Other Non Catholic Church

Date of Baptism

If Other than St. Bede, Please Provide Name of Parish/Church

Address of Parish/Church Where Baptized

Street 1

Street 2

City

State

Zip

If Not Baptized in the Catholic Faith, Please Specify Which Religion:

Date of First Reconciliation

If Other than St. Bede, Please Provide Name and Address Where 1st Reconciliation was Received

Date of First Communion

If Other than St. Bede, Please List Name and Address Where 1st Communion was Received

2018-2019 Program Requested
Required*

	PREP Sunday
	PREP Home Study (GR. 3 to 6 only)

Previous Religious Education

If student has been in a program at another Catholic parish, please list parish name.

General Information

Is Family Currently Registered as St. Bede Parishioner?
Required*

	Yes
	No

Special Circumstances

Please explain any special needs or circumstances that we should know about regarding this student include both medical and non medical.

Permission to Use Student's Photo (without name) in Bulletin or on St. Bede Website?

Required*

Parent/Guardian #1 Information

Name	Required*
Relationship to Child	Required*
Occupation	Required*
Primary Phone Number	Required* -- ext
Secondary Phone Number	-- ext
E-mail	Required*
Religion	Required*
Marital Status	Required*
Maiden Name (if applicable)

Parent/Guardian #2 Information (if applicable)

Name
Occupation
Primary Phone	-- ext
Secondary Phone	-- ext
E-mail
Religion
Marital Status
Maiden Name (if applicable)

Family Commitment

	Each family is asked to lend a helping hand in the Prep Office in a variety of ways - by donating 5 hours of time, by purchasing supplies or by buying out their responsibility.
My Family Will:		If you select to buy supplies, you will receive a list of needed supplies, you can pick one up in the PREP Office or download one from the PREP web page. If you choose to buy out your commitment, you may do so at the time you pay your registration fees. If you are volunteering, the Prep Office will schedule you based upon your availability and will get back to you with the final dates.
If You Choose to Volunteer for Your Commitment:	To volunteer on Sunday from 9:00am to 10:00am, list up to 5 dates you would like to help out:
	List up up to 5 alternate dates for volunteering on Sunday between 9:00am and 10:00 am:
	To volunteer on Sunday from 10:15am to 11:30am, list up to 5 dates you would like to help out:
	List up to 5 alternate dates for Sunday between 10:15am and 11:30am:

Emergency Contact Information

In the event neither parent nor guardian can be reached, please contact:

Name

First Name*

Last Name*

Relationship to Child

Required*

Address

Street 1*

Street 2

City*

State*

Zip*

Phone

Required* --

Child's Health Insurance Provider

Required*

Group #*

Subscriber*

Doctor's Name

Required*

Doctor's Phone Number*

Doctor's Address*

Dentist's Name

Required*

Dentist's Phone Number*

Dentist's Address*

Payment Processing

Shopping Basket

		Quantity	Extended

	First Student Registration (Parishioner) \| $125.00
	Each Additional Student Registration (Parishioner) \| $90.00
	Each Student Registration (Non-parishioner) \| $175.00
	Family Commitment Buy Out \| $50.00
	Late Fee (after May 1, 2018) \| $50.00

Order Summary

Subtotal
Discount
Sales Tax
Shipping & Handling
Total

Payment Type Credit Card
ACH / eCheck

Credit Card

Name on Card
First Name*	Last Name*

Card Number* - - -

Accepted Types

Security Code (CVV2)* | What's this?

Expiration Date*

Billing Address

Street 1*

Street 2

City*

State*

Zip*

Provide the billing address

Phone Required* -- Provide a contact phone number for the billing contact.

ACH / eCheck

Name on Account
First Name*	Last Name*

Routing Number*

Account Number*

What type of account is this?*
Checking
Savings

Billing Address

Street 1*

Street 2

City*

State*

Zip*

Provide the billing address

Phone Required* -- Provide a contact phone number for the billing contact.

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PREP Online Registration/Payment Form 2018-2019

Complete One Registration Per Student

First Student Registration (Parishioner) | $125.00

Each Additional Student Registration (Parishioner) | $90.00

Each Student Registration (Non-parishioner) | $175.00

Family Commitment Buy Out | $50.00

Late Fee (after May 1, 2018) | $50.00

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