PREP Online Registration

1. PRIMARY PARENT/GUARDIAN INFORMATION

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
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.
Relationship to Student (Select all that apply.) Mother Father Stepmother Stepfather Grandparent Guardian Family Member (not listed above) Other
Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.
Cell Phone Number (used for communication purposes) REQUIRED Please fill out this field. Please enter a phone number.
Email (will be used for communication purposes.) REQUIRED Please fill out this field. Please enter an email address.
Name of CHURCH parish where you attend Mass. REQUIRED Please fill out this field. Please enter valid data.
EMERGENCY CONTACT DURING PREP Emergency contact information (during PREP hours) is listed previously in #1. Primary Parent/Guardian Information. Emergency contact information (during PREP hours) is provided next in #2. Other Parent/Guardian Information.
WILL YOU VOLUNTEER? (Check all that you are interested in.) (All volunteers MUST pass a background check and take the Diocese of Lake Charles Safe Environment course prior to volunteering.) Catechist/Teacher Catechist/Teacher Assistant Substitute (need at least 2 for every session.) Office Assistant (need at least 2 for every session) Arrival/Dismissal (assist with drop off and pick up of elementary students) Security Not at this time.
Volunteers (Select the class times that you are available.) Session 1: 4:00pm-5:00pm (1st-5th grades) Session 2: 5:30pm-6:30pm (1st-5th grades) Session 3: 7:00-8:15pm (6th-12th grades) Not at this time.

2. OTHER PARENT/GUARDIAN/EMERGENCY CONTACT INFORMATION (if different than above)

First Name Please enter valid data.

Last Name Please enter valid data.
Address Please enter valid data.
City Please enter valid data.

State

Zip Please enter a zip code.
Home Phone Number Please enter a phone number.
Cell Phone Number (used for communication purposes) Please enter a phone number.
Email (will be used for communication purposes.) REQUIRED Please fill out this field. Please enter an email address.
Relationship to Student (Select all that apply.) Mother Father Stepmother Stepfather Grandparent Guardian Family Member (not listed above) Emergency Contact (during PREP hours) Other

Please mail correspondence to the OTHER CONTACT address listed in #2 above.

II. STUDENT INFORMATION

{ You must fill in the number of students that you will register in the blank below (ex: 1,2, 3, ) before the form will provide you with blanks to give student name, age, grade, etc.}

How many students are you registering? REQUIRED Please fill out this field.
STUDENT NAME 1
- Student's First Name REQUIRED Please fill out this field. Please enter valid data.
- Student's Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Student's Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (xx-xx-xxxx) REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Please fill out this field.
- PREP Formation Grade for Upcoming Year (2018-2019) REQUIRED Please fill out this field.
- Class Times (Select the session you would like your student to attend.) REQUIRED
  Students are placed in classes on a first-come first-serve basis. The 4:00 classes fill up quickly.
  Please fill out this field.
- Sacraments Received (check all that apply)
- Name of CHURCH where STUDENT baptized REQUIRED Please fill out this field. Please enter valid data.
- Name of CITY of CHURCH of Baptism REQUIRED Please fill out this field. Please enter valid data.
- YEAR of Student Baptism REQUIRED Please fill out this field. Please enter valid data.
- Additional Information about your child (physical, educational, medical information or needs, etc.) Please enter valid data.
STUDENT NAME 2
- Student's First Name REQUIRED Please fill out this field. Please enter valid data.
- Student's Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Student's Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- PREP Formation Grade for Upcoming Year (2018-2019) REQUIRED Please fill out this field.
- Class Times (Select the session you would like your student to attend.) REQUIRED
  Students are placed in classes on a first-come first-serve basis. The 4:00 classes fill up quickly.
  Please fill out this field.
- Sacraments Received (check all that apply)
- Name of CHURCH where STUDENT baptized REQUIRED Please fill out this field. Please enter valid data.
- Name of CITY of CHURCH of Baptism REQUIRED Please fill out this field. Please enter valid data.
- YEAR of Student Baptism REQUIRED Please fill out this field. Please enter valid data.
- Additional Information about your child (physical, educational, medical information or needs, etc.) Please enter valid data.
- Date of Birth (xx-xx-xxxx) REQUIRED Please fill out this field. Please enter a date.
STUDENT NAME 3
- Student's First Name REQUIRED Please fill out this field. Please enter valid data.
- Student's Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Student's Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- PREP Formation Grade for Upcoming Year (2018-2019) REQUIRED Please fill out this field.
- Class Times (Select the session you would like your student to attend.) REQUIRED
  Students are placed in classes on a first-come first-serve basis. The 4:00 classes fill up quickly.
  Please fill out this field.
- Sacraments Received (check all that apply)
- Name of CHURCH where STUDENT baptized REQUIRED Please fill out this field. Please enter valid data.
- Name of CITY of CHURCH of Baptism REQUIRED Please fill out this field. Please enter valid data.
- YEAR of Student Baptism REQUIRED Please fill out this field. Please enter valid data.
- Additional Information about your child (physical, educational, medical information or needs, etc.) Please enter valid data.
- Date of Birth (xx-xx-xxxx) REQUIRED Please fill out this field. Please enter a date.

III. IMMACULATE CONCEPTION PREP POLICIES

A. Immaculate Conception PREP Discipline Policy

All students must show respect in their behavior, care of the facility and manner of dress.
Cell phones must be turned off at all times, or they will be confiscated until the end of class. Use of any other electronic devices while on our campus is also prohibited.
Students must not disrupt the teaching process for the Catechist (Teacher), or the learning process for fellow students through disruptive or non-cooperative behavior.
Students must exhibit Christian concern for others by avoiding ostracizing behavior such as bullying or gossiping.
If a student commits an infraction of these policies, he or she will be sent to the PREP Office to meet with the Parish Catechetical Leader (PCL) and depending on the event, may or may not be sent back to class that evening.
For repeated offenses, the Parent will be asked to meet with PREP STAFF to discuss appropriate interventions, which could include having the Parent attend class with the student until the behavior is resolved.
It is important that we have your support in this Discipline Policy.

A. Immaculate Conception PREP Discipline Policy I agree to the Immaculate Conception PREP Discipline Policy for my student. I disagree with the Immaculate Conception PREP Discipline Policy and will contact the PREP office to discuss further.

B. Immaculate Conception Internet Video & Photograph Policy
To help our students express their faith to the community, and to help the community understand the options for faith formation for young people at Immaculate Conception, the PREP office may publish pictures or videos of our students in PREP or VBS activities to our website, social media (ex: Facebook) or other forum such as church bulletins. It is important that we have your permission to do so prior to publication.

B. Immaculate Conception Video & Internet Photograph Policy I agree and I give permission to Immaculate Conception to follow the Video & Internet Policy. I disagree and I do not give permission to Immaculate Conception to follow the Video & Internet Policy for my student (s).

C. Diocese of Lake Charles Safe Environment and Circle of Grace Lessons
The Diocese mandates that we conduct Safe Environment Education for Catechists, Volunteers, Parents, and Students. This education promotes a deeper understanding of the human person as graced and loved by God. Students are taught each year, in an age-appropriate way, the basic vocabulary and understanding of what it means to guard one's own well-being and also the well-being of those around them. They are taught to recognize abuse in all its forms, and how to address it if it is seen. While Circle of Grace is not intended to intrude on personal modesty boundaries, sometimes the subject matter brings forth sincere questions from the students. The Catechist either responds accurately to the questions, or if appropriate, refers the question to the Parent. It is important that we have your permission for Circle of Grace lessons to be taught to your child.

C. Diocese of Lake Charles Safe Environment and Circle of Grace Policy I agree and I give permission to Immaculate Conception to follow and teach the Diocese of Lake Charles Safe Environment and Circle of Grace Lesson. I disagree and I do not give permission to Immaculate Conception to follow and teach the Diocese of Lake Charles Safe Environment and Circle of Grace Lesson to my student(s). I will contact the PREP office to discuss in further detail.

IV. SELECT PAYMENT OPTION BELOW: REQUIRED Payment will be submitted online. (You will be given the opportunity to pay online when you click the SUBMIT option at the end of the form.) Payment by check or cash will be forwarded to the Church. (Make checks payable to Immaculate Conception PREP) Bill me at a later date. Please fill out this field.

PAY ONLINE INSTRUCTIONS

AFTER you select the SUBMIT button below, you will be given the option to PAY ONLINE. THEN, please follow the instructions below:

1- Select the payment amount. (ex: 1 student 25.00)
2-Then select PAY NOW.
3- You will be redirected to a paypal login screen. If you do NOT want to pay with PAYPAL or if you Do NOT have a PAYPAL Account you do NOT have to LOGIN.
4- Scroll down the screen and select pay with debit or credit card.
5- You will then have the OPTION to checkout as a PAYPAL Guest and can use a credit card or debit card even if you do NOT have a PAYPAL Account.

Immaculate Conception

Catholic Church

Prep Registration Form Instructions

I. Parent/Guardian/Adult Information

II. STUDENT INFORMATION

III. IMMACULATE CONCEPTION PREP POLICIES