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PREP Registration 2018-2019
Immaculate Conception Parish * 770 Deerfield Rd. Highland Park, IL 60035 * 847-433-0130 * prepoffice@icparish.org
Family Last Name(s) *
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Father's first/last name
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Mother's first, maiden, last name *
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Primary home address *
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secondary address if applicable
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City *
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State *
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Zip Code *
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Mother's cell phone number *
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Father's cell phone number *
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Alternate emergency contact *
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Mother's email address *
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Father's email address *
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Are you a registered parishioner at Immaculate Conception Parish? *
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