Registration Form

• Contact Info

• Father's Name: *
• Religion: *
• Mother's Name: *
• Religion: *
• Legal Guardian's Name: *
• To whom should communication be sent:
• Name: *
• Relation to Student: *
• Address for Communications: *
• Email for Communications: *
• Preference: * US MailEmail
• Home Phone: *
• Cell Phone(s): *
• Emergency Contact & Relationship: *
• Phone: *

• Student #1 Info

• Student's Name: *
• Date of Birth: *
• School: *
• Grade in Fall: *
• Medical/Allergies/Behavioral Concerns: *
• Is your child new to our program? * YesNo
• If yes, what was the name of previous program?
• Please include a copy of his/her Baptismal Certificate as well as a list of all Sacraments s/he has received (sacrament, date, church, city, state)
• Upload Baptismal Certificate *
• List of Sacraments Received * (please include the sacrament, date, church, city and state)

• Student #2 Info

• Student's Name:
• Date of Birth:
• School:
• Grade in Fall:
• Medical/Allergies/Behavioral Concerns:
• Is your child new to our program? YesNo
• If yes, what was the name of previous program?
• Please include a copy of his/her Baptismal Certificate as well as a list of all Sacraments s/he has received (sacrament, date, church, city, state)
• Upload Baptismal Certificate
• List of Sacraments Received (please include the sacrament, date, church, city and state)

• Student #3 Info

• Student's Name:
• Date of Birth:
• School:
• Grade in Fall:
• Medical/Allergies/Behavioral Concerns:
• Is your child new to our program? YesNo
• If yes, what was the name of previous program?
• Please include a copy of his/her Baptismal Certificate as well as a list of all Sacraments s/he has received (sacrament, date, church, city, state)
• Upload Baptismal Certificate
• List of Sacraments Received (please include the sacrament, date, church, city and state)

• Permission, Verification, and Fees

• I give permission for my child's picture to be used on the parish website or other social media and publications. (Children's name in pictures are not used.)
• I have read the Religious Education Guidelines and agree to the requirements of the program, including the Code of Conduct.
• I hereby verify that the above information is accurate to the best of my knowledge.
• Parent/Guardian Name: *
• Date: *
• Class Fees cover books and other Religious Education Material.

• Class Fees

• Parishioners: * One Child ($50)Two or More Children ($75)

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