PSR/Youth

Parish School of Religion

2025 May Crowning at Closing Sessionof PSR

DIRECTOR OF RELIGIOUS EDUCATION CONTACT INFO

Church Registration Form

Our Lady of the Cove, Kimberling City

New Option

Is Student's Family Registered at Our Lady of the Cove Parish?

Yes

No/ Please connect Mary L. (417)-739-4701 Ext 202

Payment Is due Wednesday, 9th of September (First day of class)

1 Student $30

2 Students $35

3 or more $40

Do another Registration

More than one student resistering? Please complete individual forms.

Number of Registration Forms

Students Family Surname

Date

Street Address

City

State

Zip

Parent Phone Contact Number

Email Address for PSR information.

Do you live in the area year round or seasonally?

Year Round

Seasonally

Preferred Language

English

Spanish

Not Applicable

MALE

Parent Information

Father

Father

First Name

Last Name

Primary Phone Number

Religion

Mother

Mother

First Name

Last Name

Primary Phone Number

Religion

Guardian

Guardian's Contact Name

First and Last Name

Guardian's Number

Emergency

Emergency Contact Information

Emergency Contact Name

Emergency Contact Relationship to Student

Emergency Contact Number

Household

Student To Attend

First NAME

Last Name

Son/Daughter

Birthdate

Age this Fall

Sacraments (Please check what has ben received

Baptisim

Reconciliation

First Eucharist

Comfirmation

Allergies ( food, insect, etc.), Special Needs

Person(s) other than yourself/sibling to student who may transport this student to and from PSR.

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 Granted

NO-Permission Granted

PARENT / GUARDIAN NAME FOR PERMISSION

Date

Welcome

Note: Please check your email for a Welcome/Thank you and if needed a link to do another form. Thank you

PSR/Youth

Parish School of Religion

PSR Registration 2025-2026

Church Registration Form

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