Religious Eductation Registration Form

Please fill out this registration form and submit. Thank you for your time we look forward to seeing you soon.

Religious Education Registration

Student's Name

First Name*

Last Name*

Mailing Address

Street 1*

Street 2

City*

State*

Zip*

Date of Birth

Required* //

Religious Education Grade Level

Student's Father

First Name

Last Name

Student's Mother

First Name

Last Name

Daytime Phone

Phone

Required* -- ext

Alternate Contact

First Name*

Last Name*

Relatioinship

Phone

-- ext

Please state any extreme Health problems (Allergies, etc.) and or learning disabilities that your child may have:

Please Complete the information below

Please mark which Sacraments the student has already received
Required*

	Baptisim
	1st Communion

	Reconcilliation (Confession)
	Confirmation

Name of Church Where Baptized

Year Baptized

Address of the Church Baptized

Street 1

Street 2

City

State

Zip

Payment

Book Donation Fee	$15-One Child $25-Family