2020-2021 First Reconciliation and First Communion
Last Name *
First Name:
Middle Name:
Preferred Name:
Preferred email for First Reconciliation correspondence: *
Additional email for First Reconciliation correspondence:
Address:
Date of birth: *
MM
/
DD
/
YYYY
City and state of birth: *
Church of baptism: (If your student was not baptized at St. Francis Xavier, please obtain a copy of the baptism certificate dated within the last 6 months. You can request a copy from the church where your child was baptized.) *
Approximate date or year of baptism: *
MM
/
DD
/
YYYY
School: *
Grade: *
Does your child have any allergies, medical issues, or special concerns? Please explain. *
Are you registered parishioners at St. Francis Xavier? *
If you are not registered at St. Francis Xavier, what parish do you attend?
Mother's full name: *
Mother's phone number: *
Father's full name: *
Father's phone number: *
Marital status of parents: *
Are there any custody issues we need to know? Please explain.
Emergency contact other than parent: *
Emergency contact's number: *
Emergency contact's relationship to child: *
Next
Never submit passwords through Google Forms.
This form was created inside of St. Francis Xavier Church. Report Abuse