Date:

Family Last Name:

Contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail

Father:

Name
Date of Birth

Employment:

Organization
Work Phone

Religion:

Mother:

Name
Date of Birth

Employment:

Organization
Work Phone

Religion:

With whom does the child reside?

Parents
Mother
Father
Grandparents
Other

Address and Telephone #, if other than above:

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone

Sessions:  3 yrs. old------Grade 12

Check one of the class times that would be best for you.

Tuition:  $30.00 per child

Student information:

Name
Date of Birth
Grade

Please click in the boxes of the sacraments your child has received:

Baptism
Penance
Eucharist
Confirmation

Student Information

Name
Date of Birth
Grade

Please click in the boxes of the sacraments that you child has received:

Baptism
Penance
Eucharist
Confirmation

Student Information:

Name
Date of Birth
Grade

Please click in the boxes of the sacraments that your child has received:

Baptism
Penance
Eucharist
Confirmation

Student Information:

Name
Date of Birth
Grade

Please click in the boxes of the sacraments that your child has received:

Baptism
Penance
Eucharist
Confirmation

Student Information

Name
Date of Birth
Grade

Please click in the boxes of the sacraments that your child has received:

Baptism
Penance
Eucharist
Confirmation

Please enter any other information you would like us to know in this area, including any SPECIAL NEEDS (health concerns, learning disabilities, physical disabilities, etc.):