Religious Education Registration

Please fill out this form and click submit.

Date

*

Parent/Guardian

*

Address

*

Household Phone (Landline)

Cell Phone

*

Email

*

This address will receive a confirmation email

Child 1

*

Date of Birth

*

Sacraments

*

Please select all that apply.

Baptism - Yes Baptism - No 1st Comm. - Yes 1st Comm. - No Confirm. - Yes Confirm. - No N/A

School & Grade

*

Child 2

Date of Birth

Sacraments

Please select all that apply.

Baptism - YesOption Baptism - No 1st Comm. - Yes 1st Comm. - No Confirm. - Yes 1st Comm. - No N/A

School & Grade

Child 3

Date of Birth

Sacraments

Please select all that apply.

Baptism - Yes Baptism - No 1st Comm. - Yes 1st Comm. - No Confirm. - Yes Confirm. - No N/A

School & Grade

Payment

1 child ($35) 2 children ($60) 3 children ($85)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit.

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