2024-2025 Disciple Maker Formation Registration Primary Household Information
Household Last Name
Father
Father Phone Number
Mother
Mother Phone Number
Primary Email
Secondary Email
Street Address
City
Zip
Parish Membership
If other, please list:
School District
Secondary Household Information
Parent/Guardian(s) Name(s)
Relationship to Child(ren)
Primary Phone Number
Secondary Phone Number
Primary Email
Secondary Email
Street Address
City
Zip
Parish Membership
If other, please list:
Student Information
Student 1 Name (First and Last)
Date of Birth (MM/DD/YY)
Gender
Please list educational, health, or physical needs your child may have so that we can better serve your child. For example, allergies, asthma, dietary restrictions, learning or behavioral needs, IEP, etc.
Educational, Health or Physical Needs
Grade in 2024-2025 School Year
Class Selection
Student 2 Name (First and Last)
Date of Birth (MM/DD/YY)
Gender
Please list educational, health, or physical needs your child may have so that we can better serve your child. For example, allergies, asthma, dietary restrictions, learning or behavioral needs, IEP, etc.
Educational, Health or Physical Needs
Grade in 2024-2025 School Year
Class Selection
Student 3 Name (First and Last)
Date of Birth (MM/DD/YY)
Gender
Please list educational, health, or physical needs your child may have so that we can better serve your child. For example, allergies, asthma, dietary restrictions, learning or behavioral needs, IEP, etc.
Educational, Health or Physical Needs
Grade in 2024-2025 School Year
Class Selection
Student 4 Name (First and Last)
Date of Birth (MM/DD/YY)
Gender
Please list educational, health, or physical needs your child may have so that we can better serve your child. For example, allergies, asthma, dietary restrictions, learning or behavioral needs, IEP, etc.
Educational, Health or Physical Needs
Grade in 2024-2025 School Year
Class Selection
Student 5 Name (First and Last)
Date of Birth (MM/DD/YY)
Gender
Please list educational, health, or physical needs your child may have so that we can better serve your child. For example, allergies, asthma, dietary restrictions, learning or behavioral needs, IEP, etc.
Educational, Health or Physical Needs
Grade in 2024-2025 School Year
Class Selection
Emergency Contact Information
Non-Parent Emergency Contact Name
Relationship to Child(ren)
Emergency Contact Phone Number
2024-2025 Disciple Maker Formation Fees Please use the chart found at the top of this page to calculate your formation fees for the year. After submitting this form, you will be given the option to pay online via WeShare, or you can send a check (payable to St. Peter) to:
Payment Plans
Payment Plan
All information provided above is truthful to the best of my knowledge.
Electronic Signature (Please Type Full Name Below)
