Welcome to our Parish School of Religion online registration for 2020-2021. For the
 first time our returning PSR students will also be re-enrolling through this process. You
 must be a registered member of Saint Rose of Lima for your children to enroll in our
 PSR Program and before completing this form. Visit our web site at www.saintrose.org
 for more information about our PSR Program. Search under Office of Catechesis.
 You may also register to be a parishioner on the above web site. Any questions please
 contact the church office at 615-893-1843. Thank you, Dr. Ben Smith, Director of
 Catechesis

Click Submit Form to send this information to Saint Rose of Lima Catholic Church.

*Required fields

Form's Instructions Special Instructions for filling out this form:
Under Student Remarks:
In the Health Problems box please share any health concerns- Allergies, Epi Pen, any medications. Special needs (physical or learning disabilities.)
In the General Remarks box please list any church where your child received a sacrament.
Under Family Remarks:
Please list an emergency contact name and number in the event your child is sick during class. If any unusual situation that needs addressing, please contact Christina Bien (ext. 1001).
If you are interested in registering a 3 or 4 year old in our CGS (Pre-K) program the child must be potty trained.
Below this registration link on the main website page there will be a payment link if you would like to pay online. Also, you may mail or drop off a check made out to Saint Rose Catholic Church at the church office. The fee amounts will be listed on this link as well as information if financial assistance is needed.

Student 1
*First Name *Last Name Suffix
  Middle Name   Nickname
Ethnicity *Birth Date *Gender Female   Male
*Grade/Degree *Language
  Phone:6th-12th ( ) - Unlisted
  Email:6th-12th   Unlisted
Sacraments   Name Received Date
*Baptism
*First Reconciliation
*First Communion
*Confirmation
Student Remarks
  General Remarks
  Health Problems
  Other Conditions
  Remarks

Family Options  New Family  Update Existing Family  - ID/Env 
Head of Household
Title *First Name *Last Name Suffix
*Relationship   Middle Name Maiden Name
Ethnicity *Gender Female   Male
  Language *Marital Status
*Phone 1 ( ) - Unlisted
  Email 1   Unlisted

Spouse
Title   First Name   Last Name Suffix
Relationship   Middle Name Maiden Name
Ethnicity   Gender Female   Male
  Language Marital Status
  Phone 1 ( ) - Unlisted
  Email 1   Unlisted

Family Street Address
*Line 1
  Line 2
*City
*State
*ZIP

Family Phone Numbers
*Primary ( ) - Unlisted
  Other ( ) - Unlisted
Family Email Address
*Email   Unlisted
Family Remarks
*Remarks


Click Submit Form to send this information to Saint Rose of Lima Catholic Church.

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