Our Lady of the Cove Catholic Church

Kimberling City, MO

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PSR/Youth

Parish School of Religion

2023-24 Opening of PSR
Mass of the Holy Spirit
PSR Registration 2024-2025
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Is your Family Registered at Our Lady of the Cove Parish? REQUIRED Yes No Please provide parish registration form Please fill out this field.
  
  Payment is due Wednesday, September 4, 2024 REQUIRED 1 Student $30 2 Students $35 3 or more students $40 Please fill out this field.
  
  Father's Name
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Phone Number (xxx) xxx-xxxx REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Mother's Name
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Phone Number (xxx) xxx-xxxx REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Guardian's Name
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Guardian's Phone Number (xxx) xxx-xxxx REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Home Address of Children 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.
  
  Email address REQUIRED Please fill out this field. Please enter valid data.
  
  Home Phone Number (xxx) xxx-xxxx REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Emergency Contact Name
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Phone Number (xxx) xxx-xxxx REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Emergency Contact Relationship to Children REQUIRED Please fill out this field. Please enter valid data.
  
  Persons other than yourself who may transport child/children to and from PSR.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Person transporting children's relationship to the children. REQUIRED Please fill out this field. Please enter valid data.
  
  Person Transporting Child Phone Number (xxx) xxx-xxxx REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Number of Student(s) Registering in PSR from the Family REQUIRED Please fill out this field.
  
  Student 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate xx/xx/xxxx REQUIRED Please fill out this field. Please enter a date.
  
  Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies ( food, insect, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Special Needs REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received REQUIRED Baptism Reconciliation Eucharist Confirmation Please fill out this field.
  
  Provide Name and Address of Parish where Sacrament (s) were received if other that Our Lady of the Cove. REQUIRED Please fill out this field.
  
  Student 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate xx/xx/xxxx REQUIRED Please fill out this field. Please enter a date.
  
  Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies ( food, insect, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Special Needs REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received REQUIRED Baptism Reconciliation Eucharist Confirmation Please fill out this field.
  
  Provide Name and Address of Parish where Sacrament (s) were received if other that Our Lady of the Cove. REQUIRED Please fill out this field.
  
  Student 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate xx/xx/xxxx REQUIRED Please fill out this field. Please enter a date.
  
  Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies ( food, insect, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Special Needs REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received REQUIRED Baptism Reconciliation Eucharist Confirmation Please fill out this field.
  
  Provide Name and Address of Parish where Sacrament (s) were received if other that Our Lady of the Cove. REQUIRED Please fill out this field.
  
  Student 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate xx/xx/xxxx REQUIRED Please fill out this field. Please enter a date.
  
  Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies ( food, insect, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Special Needs REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received REQUIRED Baptism Reconciliation Eucharist Confirmation Please fill out this field.
  
  Provide Name and Address of Parish where Sacrament (s) were received if other that Our Lady of the Cove. REQUIRED Please fill out this field.
  
  Student 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate xx/xx/xxxx REQUIRED Please fill out this field. Please enter a date.
  
  Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies ( food, insect, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Special Needs REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received REQUIRED Baptism Reconciliation Eucharist Confirmation Please fill out this field.
  
  Provide Name and Address of Parish where Sacrament (s) were received if other that Our Lady of the Cove. REQUIRED Please fill out this field.
  
  Student 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate xx/xx/xxxx REQUIRED Please fill out this field. Please enter a date.
  
  Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies ( food, insect, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Special Needs REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received REQUIRED Baptism Reconciliation Eucharist Confirmation Please fill out this field.
  
  Provide Name and Address of Parish where Sacrament (s) were received if other that Our Lady of the Cove. REQUIRED Please fill out this field.
  
  Student 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate xx/xx/xxxx REQUIRED Please fill out this field. Please enter a date.
  
  Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies ( food, insect, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Special Needs REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received REQUIRED Baptism Reconciliation Eucharist Confirmation Please fill out this field.
  
  Provide Name and Address of Parish where Sacrament (s) were received if other that Our Lady of the Cove. REQUIRED Please fill out this field.
  
  Student 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate xx/xx/xxxx REQUIRED Please fill out this field. Please enter a date.
  
  Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies ( food, insect, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Special Needs REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received REQUIRED Baptism Reconciliation Eucharist Confirmation Please fill out this field.
  
  Provide Name and Address of Parish where Sacrament (s) were received if other that Our Lady of the Cove. REQUIRED Please fill out this field.
  
  Student 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate xx/xx/xxxx REQUIRED Please fill out this field. Please enter a date.
  
  Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies ( food, insect, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Special Needs REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received REQUIRED Baptism Reconciliation Eucharist Confirmation Please fill out this field.
  
  Provide Name and Address of Parish where Sacrament (s) were received if other that Our Lady of the Cove. REQUIRED Please fill out this field.
  
  Student 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate xx/xx/xxxx REQUIRED Please fill out this field. Please enter a date.
  
  Grade Level REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies ( food, insect, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Special Needs REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Received REQUIRED Baptism Reconciliation Eucharist Confirmation Please fill out this field.
  
  Provide Name and Address of Parish where Sacrament (s) were received if other that Our Lady of the Cove. REQUIRED Please fill out this field.
  
  I hereby GRANT or DO NOT GRANT (select one) permission for Our Lady of the Cove Catholic Church to use pictures of my child in online communications, including the parish website or bulletin, for informational or promotional purposes.
  
  Permission REQUIRED Grant Do not grant Please fill out this field.
  
  PARENT / GUARDIAN NAME FOR PERMISSION REQUIRED Please fill out this field. Please enter valid data.
  
  Date REQUIRED Please fill out this field. Please enter valid data.
  
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