Sacred Heart of Jesus -
St. Patrick Parish

Eau Claire, WI

One Bread, One Body, One Parish

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Online Registration

- Faith

Online Registration

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Online Registration Form

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Student's Home Street Address REQUIRED
Address of child and parent(s) or legal guardian
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.
Best Email to use. REQUIRED Please fill out this field. Please enter an email address.
Best Phone Number to use. REQUIRED Maximum 20 characters
Best contact phone number.
Please fill out this field. Please enter a phone number.
Additional Information (you would like the Catechist to know)
Any other parental information you want to share.
Emergency Contact (if parents cannot be reached)
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Relationship REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Students Registering for Religious Education
- Number of Students REQUIRED Please fill out this field.
- Student 1
  - Full Name REQUIRED Please fill out this field. Please enter valid data.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level REQUIRED Please fill out this field. Please enter valid data.
  - Gender Male Female
  - Does this student attend Regis Catholic Schools? (Regis students are always welcome to attend) REQUIRED Yes No Please fill out this field.
  - Dietary Limitations REQUIRED Yes No Please fill out this field.
  - Allergies REQUIRED Yes No Please fill out this field.
  - Learning Disabilities REQUIRED Yes No Please fill out this field.
  - Explanation of dietary, allergy, and learning needs, and other special needs for this student.
- Student 2
  - Full Name REQUIRED Please fill out this field. Please enter valid data.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level REQUIRED Please fill out this field. Please enter valid data.
  - Gender Male Female
  - Does this student attend Regis Catholic Schools? (Regis students are always welcome to attend) REQUIRED Yes No Please fill out this field.
  - Dietary Limitations REQUIRED Yes No Please fill out this field.
  - Allergies REQUIRED Yes No Please fill out this field.
  - Learning Disabilities REQUIRED Yes No Please fill out this field.
  - Explanation of dietary, allergy, and learning needs, and other special needs for this student.
- Student 3
  - Full Name REQUIRED Please fill out this field. Please enter valid data.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level REQUIRED Please fill out this field. Please enter valid data.
  - Gender Male Female
  - Does this student attend Regis Catholic Schools? (Regis students are always welcome to attend) REQUIRED Yes No Please fill out this field.
  - Dietary Limitations REQUIRED Yes No Please fill out this field.
  - Allergies REQUIRED Yes No Please fill out this field.
  - Learning Disabilities REQUIRED Yes No Please fill out this field.
  - Explanation of dietary, allergy, and learning needs, and other special needs for this student.
- Student 4
  - Full Name REQUIRED Please fill out this field. Please enter valid data.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level REQUIRED Please fill out this field. Please enter valid data.
  - Gender Male Female
  - Does this student attend Regis Catholic Schools? (Regis students are always welcome to attend) REQUIRED Yes No Please fill out this field.
  - Dietary Limitations REQUIRED Yes No Please fill out this field.
  - Allergies REQUIRED Yes No Please fill out this field.
  - Learning Disabilities REQUIRED Yes No Please fill out this field.
  - Explanation of dietary, allergy, and learning needs, and other special needs for this student.
- Student 5
  - Full Name REQUIRED Please fill out this field. Please enter valid data.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level REQUIRED Please fill out this field. Please enter valid data.
  - Gender Male Female
  - Does this student attend Regis Catholic Schools? (Regis students are always welcome to attend) REQUIRED Yes No Please fill out this field.
  - Dietary Limitations REQUIRED Yes No Please fill out this field.
  - Allergies REQUIRED Yes No Please fill out this field.
  - Learning Disabilities REQUIRED Yes No Please fill out this field.
  - Explanation of dietary, allergy, and learning needs, and other special needs for this student.
- Student 6
  - Full Name REQUIRED Please fill out this field. Please enter valid data.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level REQUIRED Please fill out this field. Please enter valid data.
  - Gender Male Female
  - Does this student attend Regis Catholic Schools? (Regis students are always welcome to attend) REQUIRED Yes No Please fill out this field.
  - Dietary Limitations REQUIRED Yes No Please fill out this field.
  - Allergies REQUIRED Yes No Please fill out this field.
  - Learning Disabilities REQUIRED Yes No Please fill out this field.
  - Explanation of dietary, allergy, and learning needs, and other special needs for this student.
- Student 7
  - Full Name REQUIRED Please fill out this field. Please enter valid data.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level REQUIRED Please fill out this field. Please enter valid data.
  - Gender Male Female
  - Does this student attend Regis Catholic Schools? (Regis students are always welcome to attend) REQUIRED Yes No Please fill out this field.
  - Dietary Limitations REQUIRED Yes No Please fill out this field.
  - Allergies REQUIRED Yes No Please fill out this field.
  - Learning Disabilities REQUIRED Yes No Please fill out this field.
  - Explanation of dietary, allergy, and learning needs, and other special needs for this student.
- Student 8
  - Full Name REQUIRED Please fill out this field. Please enter valid data.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level REQUIRED Please fill out this field. Please enter valid data.
  - Gender Male Female
  - Does this student attend Regis Catholic Schools? (Regis students are always welcome to attend) REQUIRED Yes No Please fill out this field.
  - Dietary Limitations REQUIRED Yes No Please fill out this field.
  - Allergies REQUIRED Yes No Please fill out this field.
  - Learning Disabilities REQUIRED Yes No Please fill out this field.
  - Explanation of dietary, allergy, and learning needs, and other special needs for this student.
- Student 9
  - Full Name REQUIRED Please fill out this field. Please enter valid data.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level REQUIRED Please fill out this field. Please enter valid data.
  - Gender Male Female
  - Does this student attend Regis Catholic Schools? (Regis students are always welcome to attend) REQUIRED Yes No Please fill out this field.
  - Dietary Limitations REQUIRED Yes No Please fill out this field.
  - Allergies REQUIRED Yes No Please fill out this field.
  - Learning Disabilities REQUIRED Yes No Please fill out this field.
  - Explanation of dietary, allergy, and learning needs, and other special needs for this student.
- Student 10
  - Full Name REQUIRED Please fill out this field. Please enter valid data.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Grade Level REQUIRED Please fill out this field. Please enter valid data.
  - Gender Male Female
  - Does this student attend Regis Catholic Schools? (Regis students are always welcome to attend) REQUIRED Yes No Please fill out this field.
  - Dietary Limitations REQUIRED Yes No Please fill out this field.
  - Allergies REQUIRED Yes No Please fill out this field.
  - Learning Disabilities REQUIRED Yes No Please fill out this field.
  - Explanation of dietary, allergy, and learning needs, and other special needs for this student.
Parents/Guardians are needed to assist with Religious Education Programs.
Would you be willing to be a volunteer? REQUIRED
If yes, we will contact you as needed.
Catechist Substitute Catechist Classroom Helper Snacks Not able to help at this time Other (list in text field below) Please fill out this field.
Other: Please enter valid data.

TUITION COSTS	Fees	#Children	Total
First child	$60.00*	1	$60.00
Second child	$50.00*
Each Additional Child	$30.00*
1st Reconciliation Fee	$15.00
Confirmation Fee	$25.00
Total = fee x #children; Total Due = sum of all Totals.

*Regis Catholic Schools students have met this requirement. Regis families should enter the amount owed and click on "Pay Later", do not enter paymment information. Your registration will be reviewed for a tuition waiver .

*Tuition fees includes the online curriculum for homeschooling.

Use the above table to calculate your registration fees. Please remit payment with registration.

Faith Formation is very important. No child will be denied Religious Education because of inability to pay. Contact the parish office for a Tuition Waiver at (715) 832-0925.

Total Amount Due REQUIRED
Please enter the Total Due calculated from the table above.
$ Please fill out this field. Please enter a positive decimal.

Total:

Submit

Pay Now

Pay Later

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