Immaculate Conception Religious Education Registration 2018-2019
Please use this form to register for Religious Education classes at Immaculate Conception. There is a fee of $50 per family for our program (plus a $20 book fee for Confirmation and Pre-Confirmation students). You can pay anytime at the Parish Office or you can pay Jean Bussemeier on the first day of class or online through our Online Payment Portal (instructions on the Religious Education website). If you need assistance with payment, please see Jean Bussemeier.
Are you registering for the English or Spanish Religious Education Program? (the application is only available in English at this time) *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone # (If Available)
Your answer
Parent Cell #
Your answer
Second Parent Cell # (If Available)
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
Are you a registered parishioner of Immaculate Conception Church? *
If no, what parish are you registered with?
Your answer
Please list the names of up to four individuals authorized to pick up your children: *
Your answer
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