What type of instruction will the student(s) participate in? *First Communion and Confirmation are strongly recommended in-person instruction* *

Family Last Name *

Father's Name *

Father's Cell/Work Number *

Mother's Name *

Mother's Maiden Name *

Mother's Cell/Work Number *

Home Phone

Other email address

Home Address (Please include city, state, & zip code) *

Emergency Contact Name *

Emergency Contact Phone *

Are both parents catholic? *

Student #1 Name *

Student #1 Gender *

Student #1 Date of Birth *

Student #1 Grade *

Is Student #1 Catholic? *

Student #1 has received the following sacraments: *

Student #1 Special Needs (Medical, Learning Disabilities, Physical Disabilities, etc.) *

Student #2 Name

Student #2 Gender

Student #2 Date of Birth

Student #2 Grade

Is Student #2 Catholic?

Student #2 has received the following sacraments:

Student #2 Special Needs (Medical, Learning Disabilities, Physical Disabilities, etc.)

Student #3 Name

Student #3 Gender

Student #3 Date of Birth

Student #3 Grade

Is Student #3 Catholic?

Student #3 has received the following sacraments:

Student #3 Special Needs (Medical, Learning Disabilities, Physical Disabilities, etc.)

By checking the box, I understand that all families are required to be registered with St. Stephen Catholic Church. *

By checking the box, I will complete the Diocesan Form A for each student required by the Fort Worth Diocese. https://form.jotform.com/201485861427156 *

By checking the box, I understand that there will be a tuition of $35 per student or $75 per family. *

By checking the box, I understand that a copy of the student's Baptismal certificate is required to receive First Communion and Confirmation. *

By checking the box, I will read the Safe Environment form. I understand that my child will have the “Empowering God’s Children” training during class this semester. *