St. Agnes Catholic Parish, Weston, WI 715-359-5675


	Phone 715-359-5675		Fax 715-359-4392		Sunday Mass 7am & 9am		Saturday Mass 6:30pm		Weekday Mass M,T,Th.,Fr 8am Wed noon at St. Clare's Chapel

Faith Formation Registration & Medical Online Form 2010-11

Family Registration & Emergency Medical Information is required to be updated and on file each year.
You can register online, or you can simply print and return the completed registration form with payment to: Mary Maly; St. Agnes Parish, 6101 Zinser St., Schofield, WI 54476
Your info will be sent to the parish office electronically. Please note that payment must still be received in the parish office to complete registration. *One form per family*
Pre-School is for children 3 years and up - must be potty trained.
Tuition Schedule: Partial payment is due at the time of registration. Three installment payments can be made, until tuition is "Paid in Full". Tuition must be "Paid in Full" by January 1st.
- Pre-School is for children 3 years and older - must be potty trained.
- Pre-School - $20
- Kindergarten - $50 (4 payments of $12.50)
- 1st child (1 - 10th grades) $70 (4 payments of $17.50)
- 2 children - $130 (4 payments of $32.50)
- 3 children $180 (4 payments of $45.00)
- Max per family $180 (4 payments of $45.00)
Download and print the faith formation registration form here word document if you prefer not to register online.
If you have any questions or concerns, please call Mary Maly at 359-5675.

*required input

*Student #1 Last Name:*First Name: *Sex M/F:
*DOB (mm/dd/yy):*Grade in 10/11:

Student #2 Last Name:First Name:Sex M/F:
DOB (mm/dd/yy):Grade in 10/11:

Student #3 Last Name:First Name:Sex M/F:
DOB (mm/dd/yy):Grade in 10/11:

Student #4 Last Name:First Name:Sex M/F:
DOB (mm/dd/yy):Grade in 10/11:

Student #5 Last Name:First Name:Sex M/F:
DOB(mm/dd/yy):Grade in 10/11:

Father's Full Name:Mother's Full Name:*Phone:

Living with:

*Parents Street Address, City, Zip:

Father's Street Address, City, Zip:

Mother's Street Address, City, Zip:

Medical & Dental Information:
If I cannot be reached immediately, I hereby authorize the Faith Formation Program Director or Catechist
to call or drive my child to the physician, dentist, or hospital named below if a need for
emergency care exists. An ambulance may be called if necessary.

*Student #1 Name:
*Physician:*Phone:
*Dentist:*Phone:
*Hospital:*Phone:

Student #2 Name:
Physician:Phone:
Dentist:Phone:
Hospital:Phone:

Student #3 Name:
Physician:Phone:
Dentist:Phone:
Hospital:Phone:

Student #4 Name:
Physician:Phone:
Dentist:Phone:
Hospital:Phone:

Student #5 Name:
Physician:Phone:
Dentist:Phone:
Hospital:Phone:

It is extremely important to inform the Parish Faith Formation program regarding any physical, social or emotional issues, which may affect your child in sessions. Please indicate the nature of the problem. List any medication your child is taking. If more than one child, please be specific and use their names.

Please add any comments, questions or suggestions you have below. Your input is greatly valued & appreciated. Thank You!

*Date form completed:Type Initials :

Questions or Comments? Send an email to:
webmaster@stagnescatholicparish.com