Jr. High & High School Registration
Class Meets on Wednesday 6:00-8:00 pm

***Registration is not complete until payment is made***

Student Information
Name *
Your answer
Shirt size *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Check One *
Required
School Attending *
Your answer
Sacraments Received
Mark which Sacraments you (the Student) have or have not received. Give Date and Location to those that apply.
Baptism *
Date
MM
/
DD
/
YYYY
Location
Your answer
Communion *
Date
MM
/
DD
/
YYYY
Location
Your answer
Confirmation *
Date
MM
/
DD
/
YYYY
Location
Your answer
Parent Information
Name of Father/Guardian *
Your answer
Cell Number of Father/Guardian *
Your answer
Name of Mother/Guardian
Your answer
Cell Number of Mother/Guardian
Your answer
Home Phone Number *
Your answer
Street Address *
Your answer
City/State/Zip *
Your answer
Emergency Contact
***Other than Parents***
Name *
Your answer
Phone Number *
Your answer
Relationship to the Child *
Your answer
Name *
Your answer
Phone Number *
Your answer
Relationship to the Child *
Your answer
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