Religious Education Registration - St. Mary

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1136 Seminole Dr., Rockledge FL 32955

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Religious Education Registration

1 Child(ren) Information

2 Contact Information

How many children registering?*
- One child
- Two children
- Three children
- Four children
- Five children
- Six children
First child information
Name*
First Middle Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Birth Place*
City State / Province / Region
Age*
Grade*
Registering for:*
- Sunday School
- RCIA
- Youth Ministry (Middle School)
- Youth Ministry (High School)
Church of Baptism*
Address*
City State / Province / Region Country
Denomination*
- Catholic
Father's Name*
First Last
Mother's Name*
First Last
Is there anything we should know about your child?
Will this child prepare for any Sacraments this year?*
- No
- RCIA
- Baptism
- First Communion/Reconciliation
- Confirmation
Second Child Information
Name*
First Middle Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Birth Place*
City State / Province / Region
Age*
Grade*
Registering for:*
- Sunday School
- RCIA
- Youth Ministry (Middle School)
- Youth Ministry (High School)
Church of Baptism*
Address*
City State / Province / Region Country
Denomination*
- Catholic
Father's Name*
First Last
Mother's Name*
First Last
Is there anything we should know about your child?
Will this child prepare for any Sacraments this year?*
- No
- RCIA
- Baptism
- First Communion/Reconciliation
- Confirmation
Third Child Information
Name*
First Middle Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Birth Place*
City State / Province / Region
Age*
Grade*
Registering for:*
- Sunday School
- RCIA
- Youth Ministry (Middle School)
- Youth Ministry (High School)
Church of Baptism*
Address*
City State / Province / Region Country
Denomination*
- Catholic
Father's Name*
First Last
Mother's Name*
First Last
Is there anything we should know about your child?
Will this child prepare for any Sacraments this year?*
- No
- RCIA
- Baptism
- First Communion/Reconciliation
- Confirmation
Fourth Child Information
Name*
First Middle Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Birth Place*
City State / Province / Region
Age*
Grade*
Registering for:*
- Sunday School
- RCIA
- Youth Ministry (Middle School)
- Youth Ministry (High School)
Church of Baptism*
Address*
City State / Province / Region Country
Denomination*
- Catholic
Father's Name*
First Last
Mother's Name*
First Last
Is there anything we should know about your child?
Will this child prepare for any Sacraments this year?*
- No
- RCIA
- Baptism
- First Communion/Reconciliation
- Confirmation
Fifth Child Information
Name*
First Middle Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Birth Place*
City State / Province / Region
Age*
Grade*
Registering for:*
- Sunday School
- RCIA
- Youth Ministry (Middle School)
- Youth Ministry (High School)
Church of Baptism*
Address*
City State / Province / Region Country
Denomination*
- Catholic
Father's Name*
First Last
Mother's Name*
First Last
Is there anything we should know about your child?
Will this child prepare for any Sacraments this year?*
- No
- RCIA
- Baptism
- First Communion/Reconciliation
- Confirmation
Sixth Child Information
Name*
First Middle Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Birth Place*
City State / Province / Region
Age*
Grade*
Registering for:*
- Sunday School
- RCIA
- Youth Ministry (Middle School)
- Youth Ministry (High School)
Church of Baptism*
Address*
City State / Province / Region Country
Denomination*
- Catholic
Father's Name*
First Last
Mother's Name*
First Last
Is there anything we should know about your child?
Will this child prepare for any Sacraments this year?*
- No
- RCIA
- Baptism
- First Communion/Reconciliation
- Confirmation

Contact Information
Primary phone*
Secondary phone
Email*
Enter Email Confirm Email
Emergency Contact Name*
First Last
Emergency Contact Phone*
Relationship to child(ren)*
Who is authorized to pick up child(ren)?*
Signature*
I understand this is a legal representation of my signature.
Printed Name*
First Last
Date of signature*
Date Format: MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

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1136 Seminole Dr. Rockledge, FL 32955

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