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St. Luke's Atrium and CCD Registration 2019-2020
Email address *
Untitled Title
Child's Full Name (child 1 age and grade) *
Your answer
Child's Full Name (child 2 age and grade)
Your answer
Child's Full Name (child 3 age and grade)
Your answer
Child's Full Name (child 4 age and grade)
Your answer
Child's Full Name (child 5 age and grade)
Your answer
Child's Full Name (child 6 age and grade)
Your answer
Atrium Level 1 (age 3-6), Pre-school-K please select
Atrium Level 2 (Grades 1 & 2)
Atrium Level 3 (Grades 3-6)
First year of the 2 year Confirmation Class (Grade 7/8/9)
Confirmation Class
Birthday child 1
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Birthday child 2
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Birthday child 3
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Birthday child 4
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Birthday child 5
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Birthday child 6
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School *
Your answer
Has the child received the Sacrament of Baptism? *
If "Yes" to the previous question, when and where (church name and town) were they baptized? *
Your answer
If "No" would you like to talk with someone about receiving this Sacrament? *
Has your child recieved his/her First Communion *
If "Yes" to the previous question, when and where did he/she receive this Sacrament? *
Your answer
If "No" would you like to talk with someone about receiving this Sacrament? *
Father's Full Name *
Your answer
Father's Home Phone *
Your answer
Father's Cell Phone *
Your answer
Mother's Full Name *
Your answer
Mother's Home Phone (if different)
Your answer
Mother's Cell Phone *
Your answer
Child Resides With: *
Address (Street, Town/City, State, Zip) *
Your answer
Emergency Contact (Name, Relationship to Child, and Phone Number) *
Your answer
Does your child have any known allergies? *
If "Yes" please explain:
Your answer
Would you like to volunteer to help in Atrium?
Does your child have any medical conditions that we need to be aware of? *
If "Yes" please explain:
Your answer
Please give any information concerning your child which will be helpful in his/her experience in group settings (such as play, eating habits, special fears, special likes or dislikes).
Your answer
I/we the undersigned being the lawful parent(s) and/or guardian(s) of the above child, hereby consent to the participation of the named child/children in all activities conducted as part of the religious education program of St. Luke's Parish. (Please type name and date below) *
Your answer
I/we, the undersigned, authorize that photographs of my child may be taken during the Religious Education program of St. Luke's to be used in promotional material for our parish. (Please type name and date below) *
Your answer
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