religious education Registration Form

Student First Name

Student Middle Name

Student Last Name

Grade Student is Entering

Student's Birth Date

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Phone

(###)

###

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Sacrament: Baptism

Name, Date, Church, City, State

Sacrament: First Communion

Name, Date, Church, City, State

Sacrament: Reconciliation

Name, Date, Church, City, State

Father's Name

First Name

Last Name

Father's Marital Status

Father's Religion

Father's Phone

(###)

###

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Father's Address (if different than above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's Name

First Name

Last Name

Mother's Marital Status

Mother's Religion

Mother's Phone

(###)

###

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Mother's Address (if different than above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

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Emergency Contact Relationship to Student

Your Physician

Your Hospital Preference

Physical or Developmental Problems (If Any)