PSR Registration For Grades 1,3,4,5,6,7,8 and 9

Child 1 Name *

Child 1 Grade *

Child 1 School Attending *

Child 2 School Attending

Child 2 Name

Child 2 Grade

Child 3 Name

Child 3 Grade

Child 3 School Attending

Mother's Full Name *

Father's Full Name *

Mailing Address *

Parent Email *

Home Phone *

Work Phone *

Mother's Cell Phone *

Father's Cell Phone *

Emergency Phone *

Student's Cell Phone

Any special needs (allergies, medications, etc.)? *

Who May Pick Up Your Child from PSR? *

NO FEES. Please make a donation directly to St. John the Evangelist Church, Plaquemine, LA.

Message

57805 Main Street
Plaquemine, Louisiana 70764

Phone: 225-687-2402
Fax: 225-687-1587
Prayer Line: 225-687-1554

E-mail: stjohnchurchplaq@coxbusiness.net