Religious Education Registration

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- Are you new to the OLPH Religious Education program? REQUIRED Please fill out this field.
- Primary Contact
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED 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.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Home Phone Number Maximum 20 characters Please enter a phone number.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Are you a registered parishioner at OLPH? REQUIRED Please fill out this field.
- If you answered 'No' above, please take a moment to register in our parish by visiting
  www.olphoakland.org/register-with-olph
- Marital Status REQUIRED Please fill out this field.
- Are you interested in volunteering in our program this year? REQUIRED Please fill out this field.
- SECONDARY CONTACT
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Home Phone Number Maximum 20 characters Please enter a phone number.
- Secondary Contact's Complete Address if different from Primary Contact.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Are you interested in volunteering in our program this year? REQUIRED Please fill out this field.
- * Participation in each program is subject to availability.
- EMERGENCY CONTACT 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.
- Relationship to Student: REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Home Phone Number Maximum 20 characters Please enter a phone number.
- Which program will your family participate in this year?* (Check all that apply) REQUIRED Family Catechesis (K - 7th grade) Wednesday Program (1st - 7th grade) Confirmation Program (8th & 9th grades only) Please fill out this field.
- How many student's are you registering in this year's program? REQUIRED Please fill out this field.
  
  Student 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth (City and State) REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Grade for the 2025-2026 School Year REQUIRED Please fill out this field.
  
  Name of the school student attends. REQUIRED Please fill out this field. Please enter valid data.
  
  School District REQUIRED Please fill out this field. Please enter valid data.
  
  STUDENT HEALTH INFORMATION
  
  Immunizations are up to date. REQUIRED Please fill out this field.
  
  Has a medical condition? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Allergies? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Individual Education Program (IEP) or 504 Plan? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical Emergency:
  I understand that in the case of injury or illness, every effort will be made to contact me in a medical emergency. In the event I cannot be reached, I give permission to parish staff to secure all proper and necessary treatment for my child(ren). I understand that no liability is assumed by the church or the Archdiocese for claims that may arise.
  
  Do you agree with the medical statement above? REQUIRED Please fill out this field.
  
  Parental Consent for Medical Care
  Parental Consent for Medical Care: In case of an emergency, I give permission for my child to receive emergency medical treatment and, if necessary, be transported to the nearest appropriate medical facility.
  
  Do you give consent for medical care as described above? REQUIRED Please fill out this field.
  
  Photo Release
  Photos of my child may be taken and used in parish publications, including online and print media.
  
  Do you give consent for photo usage as described above? REQUIRED Please fill out this field.
  
  Student 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth (City and State) REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Grade for the 2025-2026 School Year REQUIRED Please fill out this field.
  
  Name of the school student attends. REQUIRED Please fill out this field. Please enter valid data.
  
  School District REQUIRED Please fill out this field. Please enter valid data.
  
  STUDENT HEALTH INFORMATION
  
  Immunizations are up to date. REQUIRED Please fill out this field.
  
  Has a medical condition? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Allergies? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Individual Education Program (IEP) or 504 Plan? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical Emergency:
  I understand that in the case of injury or illness, every effort will be made to contact me in a medical emergency. In the event I cannot be reached, I give permission to parish staff to secure all proper and necessary treatment for my child(ren). I understand that no liability is assumed by the church or the Archdiocese for claims that may arise.
  
  Do you agree with the medical statement above? REQUIRED Please fill out this field.
  
  Parental Consent for Medical Care
  Parental Consent for Medical Care: In case of an emergency, I give permission for my child to receive emergency medical treatment and, if necessary, be transported to the nearest appropriate medical facility.
  
  Do you give consent for medical care as described above? REQUIRED Please fill out this field.
  
  Photo Release
  Photos of my child may be taken and used in parish publications, including online and print media.
  
  Do you give consent for photo usage as described above? REQUIRED Please fill out this field.
  
  Student 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth (City and State) REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Grade for the 2025-2026 School Year REQUIRED Please fill out this field.
  
  Name of the school student attends. REQUIRED Please fill out this field. Please enter valid data.
  
  School District REQUIRED Please fill out this field. Please enter valid data.
  
  STUDENT HEALTH INFORMATION
  
  Immunizations are up to date. REQUIRED Please fill out this field.
  
  Has a medical condition? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Allergies? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Individual Education Program (IEP) or 504 Plan? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical Emergency:
  I understand that in the case of injury or illness, every effort will be made to contact me in a medical emergency. In the event I cannot be reached, I give permission to parish staff to secure all proper and necessary treatment for my child(ren). I understand that no liability is assumed by the church or the Archdiocese for claims that may arise.
  
  Do you agree with the medical statement above? REQUIRED Please fill out this field.
  
  Parental Consent for Medical Care
  Parental Consent for Medical Care: In case of an emergency, I give permission for my child to receive emergency medical treatment and, if necessary, be transported to the nearest appropriate medical facility.
  
  Do you give consent for medical care as described above? REQUIRED Please fill out this field.
  
  Photo Release
  Photos of my child may be taken and used in parish publications, including online and print media.
  
  Do you give consent for photo usage as described above? REQUIRED Please fill out this field.
  
  Student 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth (City and State) REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Grade for the 2025-2026 School Year REQUIRED Please fill out this field.
  
  Name of the school student attends. REQUIRED Please fill out this field. Please enter valid data.
  
  School District REQUIRED Please fill out this field. Please enter valid data.
  
  STUDENT HEALTH INFORMATION
  
  Immunizations are up to date. REQUIRED Please fill out this field.
  
  Has a medical condition? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Allergies? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Individual Education Program (IEP) or 504 Plan? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical Emergency:
  I understand that in the case of injury or illness, every effort will be made to contact me in a medical emergency. In the event I cannot be reached, I give permission to parish staff to secure all proper and necessary treatment for my child(ren). I understand that no liability is assumed by the church or the Archdiocese for claims that may arise.
  
  Do you agree with the medical statement above? REQUIRED Please fill out this field.
  
  Parental Consent for Medical Care
  Parental Consent for Medical Care: In case of an emergency, I give permission for my child to receive emergency medical treatment and, if necessary, be transported to the nearest appropriate medical facility.
  
  Do you give consent for medical care as described above? REQUIRED Please fill out this field.
  
  Photo Release
  Photos of my child may be taken and used in parish publications, including online and print media.
  
  Do you give consent for photo usage as described above? REQUIRED Please fill out this field.
  
  Student 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth (City and State) REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Grade for the 2025-2026 School Year REQUIRED Please fill out this field.
  
  Name of the school student attends. REQUIRED Please fill out this field. Please enter valid data.
  
  School District REQUIRED Please fill out this field. Please enter valid data.
  
  STUDENT HEALTH INFORMATION
  
  Immunizations are up to date. REQUIRED Please fill out this field.
  
  Has a medical condition? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Allergies? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Individual Education Program (IEP) or 504 Plan? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical Emergency:
  I understand that in the case of injury or illness, every effort will be made to contact me in a medical emergency. In the event I cannot be reached, I give permission to parish staff to secure all proper and necessary treatment for my child(ren). I understand that no liability is assumed by the church or the Archdiocese for claims that may arise.
  
  Do you agree with the medical statement above? REQUIRED Please fill out this field.
  
  Parental Consent for Medical Care
  Parental Consent for Medical Care: In case of an emergency, I give permission for my child to receive emergency medical treatment and, if necessary, be transported to the nearest appropriate medical facility.
  
  Do you give consent for medical care as described above? REQUIRED Please fill out this field.
  
  Photo Release
  Photos of my child may be taken and used in parish publications, including online and print media.
  
  Do you give consent for photo usage as described above? REQUIRED Please fill out this field.
  
  Student 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Place of Birth (City and State) REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Grade for the 2025-2026 School Year REQUIRED Please fill out this field.
  
  Name of the school student attends. REQUIRED Please fill out this field. Please enter valid data.
  
  School District REQUIRED Please fill out this field. Please enter valid data.
  
  STUDENT HEALTH INFORMATION
  
  Immunizations are up to date. REQUIRED Please fill out this field.
  
  Has a medical condition? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Allergies? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Has Individual Education Program (IEP) or 504 Plan? REQUIRED Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical Emergency:
  I understand that in the case of injury or illness, every effort will be made to contact me in a medical emergency. In the event I cannot be reached, I give permission to parish staff to secure all proper and necessary treatment for my child(ren). I understand that no liability is assumed by the church or the Archdiocese for claims that may arise.
  
  Do you agree with the medical statement above? REQUIRED Please fill out this field.
  
  Parental Consent for Medical Care
  Parental Consent for Medical Care: In case of an emergency, I give permission for my child to receive emergency medical treatment and, if necessary, be transported to the nearest appropriate medical facility.
  
  Do you give consent for medical care as described above? REQUIRED Please fill out this field.
  
  Photo Release
  Photos of my child may be taken and used in parish publications, including online and print media.
  
  Do you give consent for photo usage as described above? REQUIRED Please fill out this field.
- TUITION INFORMATION
- Early Bird pricing has concluded.
  
  Tuition for the 2025-2026 School year:
  1 child = $180.00
  2 children = $290.00
  3 or more children = $380.00
  
  If your registration is received on September 1st or later, you will incur a $50.00 late fee.
  
  Sacrament Preparation fees remain the same as last year, $100 for each child receiving a sacrament in the current school year.
- Number of Children you are registering REQUIRED Please fill out this field.
- Number of children receiving the Sacrament of First Holy Communion or Confirmation in this school year. REQUIRED Please fill out this field.
Total:

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Our Lady of
Perpetual Help Church

117 Franklin Avenue / Oakland, NJ 07436

Religious Education Registration

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