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Religious Education form

- About

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- Date REQUIRED Please fill out this field. Please enter a date.
- Father's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Work/Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  Catholic? REQUIRED yes no Please fill out this field.
- Mother's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Work/Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  Catholic? REQUIRED yes no Please fill out this field.
- Custodial Parent (if different from above) Please enter valid data.
- Home Address REQUIRED Please fill out this field. 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.
- Home Phone REQUIRED Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Emergency Contact REQUIRED Please fill out this field. Please enter valid data.
- Note: If any of your children were baptized outside of this community and you have not already supplied us with a copy of each child's baptismal record, you will need to supply a copy for our files.
- How many children are you registering? REQUIRED Please fill out this field.
  
  Child 1
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
  
  Can we take your child's photo? yes no
  
  Child 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
  
  Child 3
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
  
  Can we take your child's photo? yes no
  
  Child 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
  
  Child 4
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
  
  Can we take your child's photo? yes no
  
  Child 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
  
  Child 5
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
  
  Can we take your child's photo? yes no
  
  Child 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
  
  Child 6
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
  
  Can we take your child's photo? yes no
  
  Child 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
  
  Child 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
  
  Can we take your child's photo? yes no
  
  Child 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Gender Male Female
  
  Grade Please enter valid data.
  
  Baptized Catholic? Yes No
  
  First Reconciliation received? yes no
  
  First Eucharist received? yes no
  
  Confirmed? yes no
  
  Special needs (please list any medical, physical, or learning disabilities, and allergies)
- Can we take your child's photo? yes no
- Child 3
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Date of Birth Please enter valid data.
- Gender male female
- Grade Please enter valid data.
- Baptized Catholic? yes no
- First Reconciliation received? yes no
- First Communion received? yes no
- Confirmed? yes no
- Special needs (please list any medical, physical, or learning disabilities, and allergies)
- Can we take your child's photo? yes no
- Child 4
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Date of Birth Please enter valid data.
- Gender male female
- Grade Please enter valid data.
- Baptized Catholic? yes no
- First Reconciliation received? yes no
- First Communion received? yes no
- Confirmed? yes no
- Special needs (please list any medical, physical, or learning disabilities, and allergies)
- Can we take your child's photo? yes no
Submit