Faith Formation - Registration 2016-2017
Faith Formation classes are on Sundays, 9:30 a.m. - 10:45 a.m.

"Jesus said, "Let the children come to me, and do not hinder them; for to such belongs the kingdom of heaven." -Matthew 19:14)

Contact person: Dolores Shipe
Phone: 412-661-3100
Cell: 412-760-3177
Email: dshipe@straphaelpgh.org

We are registered parishioners at:
If you answered other above, please list the name of the parish.
Your answer
Student Name
Your answer
Student Age/Grade
Your answer
Student Address
Your answer
City, Zip
Your answer
Home Phone Number
Your answer
Parent Email Address
Your answer
Student birth date
MM
/
DD
/
YYYY
Gender
School
Your answer
Date of Baptism
MM
/
DD
/
YYYY
Church of Baptism
Your answer
Church Address
Your answer
Special Needs/Allergies/Requests
Your answer
Sacraments Received (check all that apply)
If your child is receiving a sacrament this year and was not baptized at St. Raphael's, please bring a copy of his/her Baptismal Certificate to the school office (1154 Chislett St, Pittsburgh, PA 15206) attn: Dolores Shipe.
Has your child attended any previous Religious Education programs?
If you answered yes above, where did your child attend?
Your answer
If you answered yes above, for how many years?
Your answer
Mother's Name (please put maiden name in parenthesis)
Your answer
Mother's Cell
Your answer
If address is different from child, please list here.
Your answer
Father's Name
Your answer
Father's Cell
Your answer
If address is different from child's, please list here.
Your answer
Cost: $40/child or $60/family.
Emergency Contact
Please provide a contact person in the case of a medical emergency while your child is at Faith Formation. (Name, phone number, relationship to student)
Your answer
Photo/Video Release - Parent Guardian Consent Form
Your typed name here will act as your signature for the photo/video release section.
Your answer
Volunteer Opportunities
I am interested in volunteering for the Faith Formation Program (please check all that apply). Please note: All volunteers must be in compliance with the Clearance Policy established by the Diocese of Pittsburgh.
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