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Office of Safeguard the Children
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* Indicates required question
Child's Full Name
*
Your answer
Name of School or Program (i.e. Rel Ed., Confirmation, RCIA)
*
Your answer
Name of Parish or School
*
Your answer
City
*
Your answer
Grade Level/Class
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Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Confirmation Y1
Confirmation Y2
Name of Parent(s)/Guardian(s)
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