On-Line Registration Form

IMPORTANT:

PLEASE READ MY 'REGISTRATION LETTER' BEFORE REGISTERING

Choose Program REQUIRED Fall Program (September - December) Spring Program (January - April) Please fill out this field.

Choose Day REQUIRED Tuesday (4:00 - 5:30 P.M.) Sunday (9:15 - 10:45 A.M.) Please fill out this field.

Registration Fees REQUIRED Program Fee - 1 Child: $250 Program Fee - 2 or More Children: $350 Please fill out this field.

PARENT/GUARDIAN INFORMATION

Mother's Name REQUIRED Please fill out this field. Please enter valid data.
Mother's Religion REQUIRED Please fill out this field. Please enter valid data.
Father's Name REQUIRED Please fill out this field. Please enter valid data.
Father's Religion REQUIRED Please fill out this field. Please enter valid data.
Mailing Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Mother's Cell REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Mother's Address (if different from above) Please enter valid data.
Father's Cell REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Father's Address (if different from above) Please enter valid data.

EMERGENCY CONTACT INFORMATION
Name (Other than Parents) REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

Church Where Children Were Baptized REQUIRED Please fill out this field. Please enter valid data.

NEW FAMILIES: If not OLC, please e-mail or mail a copy of certificate after registering.

d.dericks@olcchurch.com

Debbie Dericks
Director of Religious Education
1799 Hamburg Turnpike
Wayne, NJ 07470

VOLUNTEER SUPPORT:

As you are aware, our program can only operate with the help of volunteers. If you are able to help in any capacity, please check off below: If you would like information on any of these areas, I am more than happy to discuss anything with you. Please also know, I fully train any new Catechist.

Volunteer Choices Catechist Aide Substitute Catechist

Please indicate grade for above volunteer choice: Please enter valid data.

PLEASE NOTE: Any adult working with children is required by the Paterson Diocese to complete the following:

1. Mandatory background check
2. A one-time 2.5 hour “Protecting God’s Children” class.

IMPORTANT: PARENTS PLEASE READ BELOW:

Permission for Child to be photographed for publicity/presentations. REQUIRED YES NO Please fill out this field.

As a parent dedicated to my child’s Catholic faith, I commit to try to attend weekly Mass with our family along with any of the required services that will take place during this coming catechetical year. My child will be in attendance for the required weeks of Religious Education unless sickness or an unforeseen circumstance arises at which time, I will supply a written note to the Religious Education Director.

Please choose: REQUIRED YES NO Please fill out this field.

Any Additional Questions/Comments

Our Lady of Consolation Church

Wayne, NJ 07470 ~ 973-839-3444

On-Line Registration Form

ON-LINE REGISTRATION FORM

IMPORTANT:

PLEASE READ MY 'REGISTRATION LETTER' BEFORE REGISTERING