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

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

Father's Name/Legal Guardian: Date of Birth Religion Gender Male Female Ethnicity

Mother's Name/Legal Guardian: Date of Birth Religion Gender Male Female Ethnicity

Emergency Contact Information

Name: Relationship: Home Phone Mobile Number

Payment Information

Using on-line payment Dropping the payment at the Parish Office