Religious Education Registration Form

Registration for Religious Education
Prayer Changes Everything

Family Information

Name of Head of Hoousehold Please enter valid data.

Mailing Address 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 Please enter an email address.

Father

Father's Name Please enter valid data.

Catholic Yes No

Mailing Address 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.

Phone Number Please enter a phone number.

Mother

Mother's Name Please enter valid data.

Catholic Yes No

Mailing Address 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.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Emergency Contact

Full Name Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Relationship to Student Please enter valid data.

Mass Attendance

Does your family attend Mass togeter? Yes No

Name of Parish Please enter valid data.

Time of Mass Please enter valid data.

Does your child / children visit another parent on Sunday? Yes No

Does your child have learning disabilities that the catechist should be aware of? Yes No

Is your child interested in training to be an Altar Server? All students who have received First Communion are eligible. Yes No

Are you interested in being a teacher or an aide in the Religious Education Program here at Saint Mary's? Yes No

At what grade level would you like to help? Please enter valid data.

Children's Information
First Child

Child's Full Name Please enter valid data.

Date of Birth Please enter valid data.

School Grade Please enter valid data.

School Name and Address Please enter valid data.

Sacraments. Where was the child baptized? Parish? 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.

Date and Parents' Names listed on the Baptismal Certificate Please enter valid data.

Needed Information Please enter valid data.

Penance: Name of Parish where celebrated? Please enter valid data.

First Communion: Name of Parish where received? Please enter valid data.

Confirmation: Name of Parish where received? Please enter valid data.

Past two years of religious education. Name of Parish Please enter valid data.

Second Child

Child's Full Name Please enter valid data.

Date of Birth Please enter valid data.

School Grade Please enter valid data.

School Name and Address Please enter valid data.

Sacraments. Where was the child baptized? Parish? 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.

Date and Parents' Names listed on the Baptismal Certificate Please enter valid data.

Needed Information Please enter valid data.

Penance: Name of Parish where celebrated? Please enter valid data.

First Communion: Name of Parish where received? Please enter valid data.

Confirmation: Name of Parish where received? Please enter valid data.

Past two years of religious education. Name of Parish Please enter valid data.

Third Child

Child's Full Name Please enter valid data.

Date of Birth Please enter valid data.

School Grade Please enter valid data.

School Name and Address Please enter valid data.

Sacraments. Where was the child baptized? Parish? 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.

Date and Parents' Names listed on the Baptismal Certificate Please enter valid data.

Needed Information Please enter valid data.

Penance: Name of Parish where celebrated? Please enter valid data.

First Communion: Name of Parish where received? Please enter valid data.

Confirmation: Name of Parish where received? Please enter valid data.

Past two years of religious education. Name of Parish Please enter valid data.

Fourth Child

Child's Full Name Please enter valid data.

Date of Birth Please enter valid data.

School Grade Please enter valid data.

School Name and Address Please enter valid data.

Sacraments. Where was the child baptized? Parish? Please enter valid data.

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 and Parents' Names listed on the Baptismal Certificate Please enter valid data.

Needed Information Please enter valid data.

Penance: Name of Parish where celebrated? Please enter valid data.

First Communion: Name of Parish where received? Please enter valid data.

Confirmation: Name of Parish where received? Please enter valid data.

Past two years of religious education. Name of Parish Please enter valid data.

Saint Mary of the Assumption

Catholic Church

Religious Education Registration Form