Religious Education Registration Online Form

Please note: All questions with * are required for the full completion of the religious education program.

Your Child's Information

Name of Student

First Name*

Middle Name

Last Name*

Grade

Required*

Age

Age*

Gender
Required*

	Male
	Female

Date of Birth

Required* //

Place of Birth

Required*

Mailing Address

Street 1*

Street 2

City*

State*

Zip*

Name of Church you belong, Since When (Year)?

Required*

Your Church Address

Street 1*

Street 2

City*

State*

Zip*

Registered Parishioner?
Required*

	Yes
	No

Has your child been to a Catholic School or Religious Education Classes?
Required*

	Yes
	No

If Yes, what Catholic School name OR RE Classes Church name; and how many yearsn

Sacraments Received
Required*

**Please submit to the parish office the copy of the Certificate(s) of the Sacraments received and the Birth Certificate if your child is not baptized.***

	Baptism
	Eucharist

	Confirmation
	Not Baptized

Special Needs: To enable us to serve your child(ren), please indicate any special needs/instructions, diet, allergies, disabilities (e.i. Autism, ADD/ADHD, or physical challengers) as well as any medication(s) your child is taking.

If there are no Special Needs, please indicate with "N/A"*

List (Multiple Choice)

No options provided!

Parent's Information

Are you registered in this parish?
Required*

	Yes
	No

Name of Father

Title

First Name*

Middle Name

Last Name*

Religion of Father

Required*

Name of Mother

Title

First Name*

Middle Name

Last Name*

Religion of Mother

Required*

Address

Street 1*

Street 2

City*

State*

Zip*

Primary Phone

Specify home, mobile, or work.* --

Secondary Phone

A confirmation email will be sent to this email address.*

Secondary E-mail

Emergency Contact Name

First Name*

Last Name*

Emergency Contact Relationship

Required*

Emergency Phone Number

Specify home, mobile, or work.* --

Your child's mode of transportation.
Required*

	Walk
	Bus
	Vehicle

Parent Involvement

Are you interested in:

	Catechist Assistant (K-8)
	Parish Event Vulunteer
	Family Activity Volunteer
	Food bagging/Distribution
	Youth Ministry: Middle/High School
	Other

Please specify other(s) involvement

Registration Fee
Required*

The Registration Fee of $25.00 can be made at the church office.*

Yes, I acknowledge.

Parent Signature
Required*

I acknowledge that as the parent/guardian, this information will be submitted to the parish for use in registration.*

Yes, I acknowledge.

Facebook Twitter Instagram