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Religious Education Registration 2022-2023
Please fill out this entire form. You will be able to pay online immediately after you submit this form. Payment and other information are available after the form is submitted. If you have more than one child please register them for their corresponding grade.
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* Indicates required question
Family Information
Full Name of the Person Registering this child
*
Your answer
Relationship to the child
*
Mother
Father
Grandparent
Guardian
Other:
Father First Name
*
If only one guardian, please specify here.
Your answer
Father Last Name
*
If only one guardian, please specify here.
Your answer
Father/Guardian Mobile Phone
The name, phone number and email MUST be listed for at least one of the parents/guardians (Only called in emergency)
Your answer
Father/Guardian E-mail
Your answer
Mother First Name
*
If only one guardian, please specify here.
Your answer
Mother Last Name
*
If only one guardian, please specify here.
Your answer
Mother Mobile Phone
The name, phone number and email MUST be listed for at least one of the parents/guardians (Only called in emergency)
Your answer
Mother/Guardian E-mail
Your answer
Parent Email for Religious Ed. updates and information
*
This email will also be used as the parent email for the online component of the program.
Your answer
Another Email to use for Religious Ed. updates and information
Your answer
Street Address
*
Your answer
Town
*
Muncy, PA
Hughesville, PA
Turbotville, PA
Picture Rocks, PA
Montgomery, PA
Clarkstown, PA
Delaware Run, PA
Other:
Zip Code
*
Your answer
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