Religious Education Registration Form

Current School Year: August 14, 2022 – June 2, 2023

Student Name(Required)

Current Grade(Required)

Current School Name(Required)

Birth Date(Required)

Address(Required)

Street Address City State ZIP Code

Parent Home Phone Number

Parent Cell Phone Number(Required)

Parent Email(Required)

Father's Name(Required)

First Last

Father's Religion(Required)

Mother's Name(Required)

First Last

Mother's Religion(Required)

Sacraments Received(Required)

Baptism

First Communion

First Reconciliation

Confirmation

None

Check All That Have Been Received for the Student

Emergency Contact Name(Required)

First Last

Emergency Contact Phone Number(Required)

Comments

This field is for validation purposes and should be left unchanged.