PSR Registration Application | 2023-24 | Immaculate Conception Catholic Church

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PSR Registration Application | 2023-24

PSR Registration Application | 2023-24

: Parish School of Religion (PSR) Registration Application | 2023-24
: Parish School of Religion (PSR) will be held September 10, 2023 -- May 5, 2024 from 9:15AM-10AM in the Parish Activity Center at Immaculate Conception Catholic Church-Baton Rouge (ICCC-BR).

The information entered on this application is considered confidential. It will be used for the sole purposes of registration and enrollment with the Parish School of Religion at Immaculate Conception Catholic Church (Baton Rouge) and the Office of Child and Youth Protection of the Diocese of Baton Rouge.

: STUDENT'S INFORMATION
First Name
Middle Name
Last Name
Suffix (If Applicable)
Gender
Date of Birth (MM/DD/YYYY)
Address (Where PSR Information Should Be Mailed)
City/State/Zip Code
Name of School Attending (2023-24 Academic Year)
School Grade Enrolled (2023-24 Academic Year)
PSR Grade Will Be Enrolled In (2023-24 PSR Year)
Last PSR Enrollment Status (2022-2023 PSR Year)
Food/Drink Allergies (Identify All)
Identify "Other" (If Applicable)
Developmental/Physical Impairments (Identify All)
Identify "Other" (If Applicable)

: SACRAMENTAL PREPARATION | First Holy Communion or Confirmation
Preparing for First Holy Communion this Spring 2024?
Preparing for Confirmation this Spring 2024?
Baptized?
Church Where Baptized
Identify "Other", If Applicable (Name of Church, Address, City, State, Zip Code)
Date of Baptism, If Applicable (MM/DD/YYYY)
: ATTENTION!
: (1) If the student was baptized at a church other than Immaculate Conception (Baton Rouge), submit a copy of the student's Baptismal Certificate to one of the PSR Administrators, Gloria DeRouen or Kalli Gregory.

(2) If the student made his/her First Holy Communion at a church other than Immaculate Conception (Baton Rouge), submit a copy of the student's First Holy Communion Certificate to one of the PSR Administrators, Gloria DeRouen or Kalli Gregory.

(3) If the student is older than 7-years-old, has not been baptized and/or has not made his/her First Holy Communion, please contact our Main Office (225-775-7067) for more details.

: PRIMARY PARENT/LEGAL GUARDIAN'S INFORMATION
: PRIMARY CONTACT
Relationship to Student
First Name
Last Name
Suffix (If Applicable)
Preferred Contact Number (Include Area Code)
Type of Contact Number
Preferred Email Address
Registered Member of Immaculate Conception (Baton Rouge)?
: SECONDARY CONTACT
Relationship to Student
First Name
Last Name
Suffix (If Applicable)
Preferred Contact Number (Include Area Code)
Type of Contact
Preferred Email Address
Registered Member of Immaculate Conception (Baton Rouge)?
: INTERESTED IN JOINING OUR ICCC FAMILY?
: (1) On this website, click the "Join Our ICCC Family" menu tab to complete and submit a New Member Registration Form OR

(2) Located in the entrance of the church, complete a hardcopy of the New Member Registration Form and give it to an usher of the Hospitality Ministry (or place it in the collection basket located in the entrance of the church)

: EMERGENCY CONTACT'S INFORMATION
Relationship to Student
Identify "Other" (If Applicable)
Preferred Contact Number (Include Area Code)
Type of Contact Number
Preferred Email Address

: LIABILITY WAIVER
As the primary parent or legal guardian, I waive, release and discharge the pastor, employees and volunteers of Immaculate Conception Catholic Church-Baton Rouge (ICCC-BR) from any and all liability that may arise from illness, negligence or personal injury/death to my child (i.e., student), and any property damage/theft to my child's (i.e., student's) belongings while he/she is on the premises of ICCC-BR and before/during/after any Parish of Religion (PSR) activities.: Yes, I agree to the terms of the above Liability Waiver.

: PHOTO/VIDEO RELEASE
As the primary parent or legal guardian, I give permission to the employees and/or volunteers of Immaculate Conception Catholic Church-Baton Rouge (ICCC-BR) and its Parish School of Religion (PSR) to take, display and post PSR-related photos and/or videos of my child (i.e., student) to ICCC-BR's website, Facebook page and inside its buildings. All PSR-related photos and/or videos will be considered ICCC-BR property, and will be used/displayed with discretion and appropriateness.: Yes, I agree to the terms of the above Photo/Video Release.No, I do not agree to the terms of the above Photo/Video Release.

: COVID-19 Safety Precautions
: Click here to edit
: Due to the possible spread of COVID-19, Parish School of Religion (PSR) students, PSR volunteers and Immaculate Conception Catholic Church-Baton Rouge (ICCC-BR) employees, parishioners, and authorized visitors are encouraged to wear a face mask and to use hand sanitizer during PSR hours of operation.

During any PSR breakfasts or other meal times, all participating diners are allowed to remove their face masks to eat and drink but must socially distance.

If a PSR student, primary parent/legal guardian, authorized visitor, ICCC-BR employee, ICCC-BR parishioner or PSR volunteer knows or suspects that he/she has contracted or has been exposed to COVID-19, he/she must quarantine, must cease attending PSR activities, and cannot enter any ICCC-BR buildings until he/she tests negative.

Disposable face masks and industrial-strength hand sanitizer will be available at all times inside the Parish Activity Center.

: REGISTRATION/SACRAMENT FEE(S)
: A. One (1) Child Enrolled = $25
B. Each Additional Child Enrolled after first enrolled child = $15 per child
C. Sacrament Fee (First Holy Communion or Confirmation), if applicable = $10 per child

PAYING BY CHECK
1. Make your check payable to "Immaculate Conception".
2. In the check's Memo section, write: "PSR 2022-23" and the name(s) of the child(ren) being registered.
3. Give your check to one of the PSR Administrators, Gloria DeRouen or Kalli Gregory OR place your check in the collection basket located in the church's entrance OR drop-off your check to the Main Office of the Ministry Building during business hours (Mon-Thu 9AM-12PM, 1PM-4PM and Fri 9AM-12PM).

PAYING ONLINE
On this Website (www.immaculateconceptionbr.org)
1. Click the "Donate Now" button or the "Online Giving" menu tab followed by clicking the "WeShare" button.
2. Click the "Welcome" icon.
3. At "Choose a Designation", click the "One-time" button.
4. At the "Fund" drop down arrow, highlight Parish School of Religion".
5. At "Amount", enter the total amount being paid (registration fees and any applicable sacrament fees).
6. Click the "Submit" button to finalize your payment transaction.

At Givelify.com
1. On the "Immaculate Conception Church (Pastor Thomas Clark)" icon of the "My Place of Worship" page, click the "Give" button.
2. On the "Select Your Gift" page, click the dollar amount button that identifies the total amount being paid (registration fees and any applicable sacrament fees).
3. Click the "Parish School of Religion" button.
4. Click the "Continue" button to finalize your payment transaction.
Your Payment Method
: Please click the "I'M NOT A ROBOT" and "SUBMIT" buttons before exiting this application. Thank you!

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