Religious Education Registration

Student Information

Name 1: Date of Birth Ethnicity School Grade: School: Gender Male Female Sacraments received: Baptism - Date: Eucharist (Communion)- Date:

Name 2: Date of Birth Ethnicity School Grade: School: Gender Male Female Sacraments received: Baptism - Date: Eucharist (Communion)- Date:

Name 3: Date of Birth Ethnicity School Grade: School: Gender Male Female Sacraments received: Baptism - Date: Eucharist (Communion)- Date:

Name 4: Date of Birth Ethnicity School Grade: School: Gender Male Female Sacraments received: Baptism - Date: Eucharist (Communion)- Date:

Name 5: Date of Birth Ethnicity Grade Student in: School: Gender Male Female Sacraments received: Baptism - Date: Eucharist (Communion)- Date:

Household Information

Head of Household Date of Birth Religion Ethnicity Gender Male Female Occupation Email address Spouse's name including Maiden Name Date of Birth Religion Ethnicity Gender Male Female Occupation

Address: City: Zip: Telephone: Home Work : Mobile:

Legal Guardian: Date of Birth Religion Gender Male Female Ethnicity Occupation

Legal Guardian: Date of Birth Religion Gender Male Female Ethnicity Occupation

Emergency Contact Information

Name: Relationship: Home Phone Mobile Number