PSR Registration

Family Name

First and Last Name of Person Completing this Registration

Relationship to Student

Street
Apt, floor, suite, etc.

City
State
Zip

Parish

If your home parish is not Annunciation or Our Lady of Providence, we will let your home parish know that your child(ren) are attending Annunciation PSR.

Number of Students Registering

Student Lives With

Witness Statement

I have read the Witness Statement and I commit myself to be the first and best teacher of my children in their faith.

Information for Student 1

Student First Name
Middle Initial
Last Name
Goes By

Date of Birth
Gender

School Attending
Grade Level 2025-2026

For students entering grade 1 or new students:

A copy of your baptism certificate must be requested from the parish the child was baptized and turned into rectory.

Baptism Date
Baptism Parish and Address

For New Students Only

First Reconciliation Date
First Reconciliation Parish

First Communion Date
First Communion Parish

For All Students

What would you like us to know about your child to help PSR staff in meeting your child’s medical, emotional, spiritual, and learning needs?

Does your child have an IEP (Individualized Education Program)?

Does child have allergies we need to be aware of?

Information for Student 2

Student First Name
Middle Initial
Last Name
Goes By

Date of Birth
gender

School Attending
Grade Level 2025-2026

For students entering grade 1 or new students: A copy of your baptism certificate must be requested from the parish the child was baptized and turned into rectory.

Baptism Date
Baptism Parish and Address

For New Students Only

First Reconciliation Date
First Reconciliation Parish

First Communion Date
First Communion Parish

For All Students

What would you like us to know about your child to help PSR staff in meeting your child’s medical, emotional, spiritual, and learning needs?

Does your child have an IEP (Individualized Education Program)?

Does child have allergies we need to be aware of?

Information for Student 3

Student First Name
Middle Initial
Last Name
Goes By

Date of Birth
Gender

School Attending
Grade Level 2025-2026

For students entering grade 1 or new students: A copy of your baptism certificate must be requested from the parish the child was baptized and turned into rectory.

Baptism Date
Baptism Parish and Address

For New Students Only

First Reconciliation Date
First Reconciliation Parish

First Communion Date
First Communion Parish

For All Students

What would you like us to know about your child to help PSR staff in meeting your child’s medical, emotional, spiritual, and learning needs?

Does your child have an IEP (Individualized Education Program)?

Does child have allergies we need to be aware of?

Parent Information

Mother

Mother's First Name
Mother's Last Name
Mother's Maiden Name

Living or Deceased"?
Marital Status
Mother's Religion

Stepfather's First Name
Stepfather's Last Name

Father

Father's First Name
Father's Last Name

Living or Deceased?
Marital Status
Father's Religion

Stepmother's First Name
Stepmother's Last Name

CONTACT INFORMATION

If not previously entered, the email addresses and phone numbers below will be entered into Annunciation’s Flocknotes (PSR group) so that you will receive communications regarding PSR activities.

Primary Phone
Belongs To
Type of Phone

Primary Email

Secondary Phone
Belongs To
Type of Phone

Secondary Email

EMERGENCY CONTACT INFORMATION

If we cannot reach the primary/secondary phone:

Emergency Contact Name
Emergency Contact Phone
Relationship to Child/ren

Dismissal

Information regarding our Sign Out Policy

Additional people allowed to pick-up my children (other than mother/father)

Authorization for Safe Touch Program

I authorize Annunciation PSR to present the Archdiocese’s Safe Touch Program to my child at age appropriate level.

ANNUNCIATION PSR MEDIA AUTHORIZATION

For marketing and publicity purposes, there may be times when Annunciation PSR wishes to use your and/or your child(ren)’s image, name, recording, or academic work in various media for marketing and/or publicity purposes. Our purpose for asking is to mainly use in the bulletin and on the website. As a parent, you may grant or deny authorization.

I grant permission to use my or my child(ren)’s image, name, recording, or academic work in communications that include, but are not limited to, the parish bulletin, PSR newsletter, parish website, social media, PSR Buzz book, PSR Yearbook.

Parish Bulletin
Parish Website
Social Media
PSR Newsletter

PSR Buzz Book (Includes photos, names, address and phone numbers)
PSR Yearbook (Includes photos and names only)

ARCHDIOCESE MEDIA AUTHORIZATION

I grant permission to use my or my child/ren's image, name recording or academic work in communications that include, but are not limited to, archstl.org, St. Louis Review, Catholic St. Louis magazine, archdiocesan social media, and any publications (s) by agencies administered by the Archdiocese of St. Louis.

Archdiocese of St. Louis

I grant permission to use my or my child/ren's image, name, recording, or academic work in websites, videos, and publications created by independent foundations and corporations that support Catholic education but are not legally connected to the Archdiocese of St. Louis, including, but not limited to, Today and Tomorrow Educational Foundation, Roman Catholic Foundation of Eastern Missouri, Access Academics, English Tutoring Project, and United Way.

Sponsoring Organizations

I grant permission to use my or my child/ren's image, name, recording, or academic work in websites, videos, and publications created by independent foundations and corporations that support Catholic education but are not legally connected to the Archdiocese of St. Louis, including, but not limited to, Today and Tomorrow Educational Foundation, Roman Catholic Foundation of Eastern Missouri, Access Academics, English Tutoring Project, and United Way.

By submitting this registration, I am granting permission for my child/ren to attend Annunciation’s PSR program and receive instruction in the theology of the Catholic faith.

Secular media outlets

1 child tuition: $275

2 child tuition: $375

3 child tuition: $450

Fees per Grade Level are due at the time of registration, in addition to tuition:

2nd Gr. Sacramental Material Fee: $40

3rd Gr. Bible Material Fee: $40

6th Gr. Bible Material Fee: $40

8th Gr. Sacramental Material Fee: $60

Private School Confirmation Preparation Registration Fee: $100

All required forms and fees are due prior to the first day of class.

REGISTRATION IS NOT COMPLETE AND STUDENT(S) WILL NOT BE ENROLLED UNTIL FULL PAYMENT HAS BEEN MADE AND ALL REQUIRED FORMS ARE SUBMITTED. Required forms may include baptism certificate (if student is new or in first grade) and custody arrangement documentation for approved pick up persons, if applicable.

The link to pay registration and fees will be provided in the confirmation email that you will receive upon completion of this form or after completing the registration form, please CLICK HERE for payment.

Register for PSR

PSR Registration

Annunciation

Our Lady of Providence