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Religious Education Student Registration
Copies of Birth Certificates and Sacramental Certificates are Required Upon Registering All NEW Students!

Fees:
$25 (Pre K/ Kindergarten); $35 (1st-5th Grade); $45 (6th-9th Grade); $90 (Confirmation Level I & II )
$30 extra for all Sacramental Preparations
$25 Late Fee will apply after July 31st

Class Times:
Pre K/ Kindergarten Will Have Separate Schedule
1st-5th Grade : Sundays 9:45 AM to 10:55 AM
6th - 11th Grade: Sundays 6:00 PM to 8:15 PM

Email address *
Student Name ( First, MI, Last) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Sex: (Male/Female) *
Grade Entering/ School Attending: *
Your answer
Place of Birth (City, State, Country) *
Your answer
Student Mailing Address *
Your answer
Registered Parishioner ( Y / N ) *
Which Mass do you attend regularly? *
Is Student Baptized? *
If yes, Baptism Date/ Location *
Your answer
Did Student Receive First Communion? *
If yes, First Communion Date/ Location *
Your answer
Marital Status of Parents *
Student live with (Check all that apply) *
Required
Who is the primary contact for the student? *
Biological Father's Name (First, MI, Last) *
Your answer
Biological Father Phone Number
Your answer
Biological Father Email Address
Your answer
Biological Father Address (If Different from Student)
Your answer
Biological Mother Name (First, MI, Last) *
Your answer
Biological Mother Phone Number
Your answer
Biological Mother Email Address
Your answer
Biological Mother Address (If Different from Student)
Your answer
Guardian Name (If Applicable) (First, MI, Last)
Your answer
Guardian Phone Number
Your answer
Guardian Email Address
Your answer
Siblings in Program & What Grade? *
Your answer
Emergency Contact Information : Name / Phone Number / Relationship to Student: *
Your answer
Name of Student's Physician / Phone Number : *
Your answer
Student Allergies? *
Your answer
Emergency Medication (inhalers, epi-pen etc...)
Your answer
Special Needs?
Your answer
A copy of your responses will be emailed to the address you provided.
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