Religious Education Registration

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Contact Details

Student Name(Required)

First Middle Last

Gender(Required)

Male

Female

Date of Birth(Required)

Age(Required)

Birth City/State/Country(Required)

City State / Province / Region Country

Grade(Required)

School(Required)

Name City State / Province / Region Country

Language(Required)

Medical Conditions(Required)

Please list any allergies or medical conditions.

Baptism(Required)

Yes

No

Unsure

Date of Baptism(Required)

Church of Baptism(Required)

Church Name City State / Province / Region Country

First Communion(Required)

Yes

No

Unsure

Date of First Communion(Required)

Church of First Communion(Required)

Church Name City State / Province / Region Country

Confirmation(Required)

Yes

No

Unsure

Date of Confirmation(Required)

Church of Confirmation(Required)

Church Name City State / Province / Region Country

Would you like to add another student?(Required)

Student #2 Name(Required)

First Middle Last

Date of Birth(Required)

Age(Required)

Birth City/State/Country(Required)

City State / Province / Region Country

Grade(Required)

School(Required)

Name City State / Province / Region Country

Language(Required)

Medical Conditions(Required)

Please list any allergies or medical conditions.

Baptism (Student #2)(Required)

Yes

No

Unsure

Date of Baptism(Required)

Church of Baptism(Required)

Church Name City State / Province / Region Country

First Communion (Student #2)(Required)

Yes

No

Unsure

Date of First Communion(Required)

Church of First Communion(Required)

Church Name City State / Province / Region Country

Confirmation (Student #2)(Required)

Yes

No

Unsure

Date of Confirmation(Required)

Church of Confirmation(Required)

Church Name City State / Province / Region Country

Parent / Parishoner Information

Father's Name(Required)

Prefix First Last

Mother's Name(Required)

Prefix First Last (Maiden)

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is family registered at St. Mary Catholic Church?(Required)

Yes

No

Emergency Contact

Please list the order in which you would like us to reach you in an emergency.

Emergency Contact # 1(Required)

Name Relationship to student

Cellphone Number(Required)

Emergency Contact # 2(Required)

Name Relationship to student

Cellphone Number(Required)

Emergency Contact # 3

Name Relationship to student

Cellphone Number

If needed, please list any additional people authorized to pick up your child(ren):

You agree to photo/video image release?(Required)

Yes

No

Signature

Payment Details

Fees are due at registration and are non-refundable. The sacrament fee is in addition to the Faith Formation Fee.

Faith Formation Registration Fee(Required)

One Student

Two Students

Sacrament Registration Fee(Required)

One Sacrament

Two Sacraments

No Sacraments this year

Total

Payment(Required)

Online (2.9 processing fee)

Check

Cash

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Credit Card

Additional information regarding payments will be provided once registration is submitted.