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PSR Registration Form

Please fill out the form below to register one or more students for PSR. A link to a printable copy is at the bottom if you prefer to print it and fill it out by hand.

  • Note: All Students will need to furnish a copy of the baptismal certificate if not baptized at SJM
  • In case of an emergency and parents are not available, contact:
  • IN CASE OF ILLNESS AND PARENT CANNOT PICK UP STUDENT FROM PSR, PARENTS MUST GIVE TELEPHONE PERMISSION FOR PERSON(S) LISTED BELOW TO PICK UP CHILD:
  • Use the plus button at the end of the row to add additional rows.
    First NameLast NameGradeSchoolDate of Birth 
    Add a new row
  • Please list any medical conditions for any of your children, including allergies, asthma, diabetes, seizures, medications, heart problems, recurring illness, or anything else we should be aware of. Use the plus button at the end of the row to add additional rows.
    Name of StudentCondtition 
    Add a new row

  • When you are finished adding siblings, please sign below.

    AUTHORIZATION AND SIGNATURE

    In case of accident or serious illness, and we and the people I designated are unable to be reached, I hereby authorize the school to call the physician and to follow his/her instructions. If this physician is unable to be contacted, the school may make whatever arrangements are deemed necessary.
  • Price: $80.00
    An $80 / Family fee is due at the time of PSR registration. This $80 Registration fee is applied to your book fee(s). The book fee is $80 per child which covers costs of texts and supplies for student.
    When you click the Submit button, you will be taken to the PayPal site where you can pay your fee with a PayPal account or with a credit card.
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