English First Communion Year Two Registration

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English First Communion Year I

Email *

Student's Name: *

Address: *

Birth City State: *

Date of Birth: *

YYYY

Age: *

Parish of Baptism: *

Date of Baptism: *

YYYY

School: *

Grade: *

Student Father's Name: *

Is Student's Father Catholic? *

Is Student's Father Married? *

Father's phone number: *

Father's email: *

Student Mother's Name: *

Is Student's Mother Catholic? *

Is Student's Mother Married? *

Mother's Phone Number: *

Mother's Email: *

Person to call in case of emergency, their relationship to student, and their phone number: *

In case of emergency, may your child receive minor first aid while in catechism: *

If you do not want student to receive first aid, please explain why: *

Does your student have any condition or allergies that we should know? *

How would you like to pay your student's $200 religious ed. registration fee? *

cash

check

credit card

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