Family Last Name

Father's Name

Father's Phone Number

Mother's Name

Mother's Maiden Name

Mother's Phone Number

Address

Home Phone Number

Family E-mail Address

We are registered parishioners at:

Child's Name (Last, First, MI)

Child's Sex

Child's Date of Birth

School Attending

Grade

Session

Grade 9-11 please select one of the following:

My child has the following special needs:

Is this child Baptized?

What faith tradition was this child Baptized into?

Date

Has this child received First Holy Communioin

Date

Has this child received First Reconciliation?

Date

Has this child been Confirmed?

Date

Emergency Contact Information