Immaculate Conception Religious Education Registration 2017-2018
Please use this form to register for Religious Education classes at Immaculate Conception. There is a fee of $50 per family for our program (plus a $20 book fee for Confirmation and Pre-Confirmation students). You can pay anytime at the Parish Office or you can pay Joy Dinaro on the first day of class or online through our Online Payment Portal (instructions on the Religious Education website). If you need assistance with payment, please see Joy Dinaro.
Are you registering for the English or Spanish Religious Education Program? (the application is only available in English at this time)
Street Address
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City
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State
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Zip Code
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Home Phone # (If Available)
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Parent Cell #
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Second Parent Cell # (If Available)
Your answer
Emergency Contact Name
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Emergency Contact Relationship
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Emergency Contact Phone Number
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Are you a registered parishioner of Immaculate Conception Church?
If no, what parish are you registered with?
Your answer
Please list the names of up to four individuals authorized to pick up your children:
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