Religious Education Registration Form – UPDATE EMAIL and check form

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Family Information

Parents' Names*

Last Name Dad’s Name Mom’s Name Mom’s Maiden Name

Home Address*

Address Address Line 2 City State ZIP Code

Home Phone*

Dad's Cell/Work Number*

Mom's Cell/Work Number*

Email Address*

Used for Main Contact

Enter Email Confirm Email

Children Live With:*

Guardian/Other Person's Name*

First Last

Guardian/Other Person's Phone*

Student Information

Only for Returning Families

Number of Students to Enter*

Student 1

Name of Student*

Gender*

Male
Female

Date of Birth*

Grade in 2020/2021*

Name of Public/Private School*

Student 2

Name of Student*

Gender*

Male
Female

Date of Birth*

Grade in 2020/2021*

Name of Public/Private School*

Student 3

Name of Student*

Gender*

Male
Female

Date of Birth*

Grade in 2020/2021*

Name of Public/Private School*

Student 4

Name of Student*

Gender*

Male
Female

Date of Birth*

Grade in 2020/2021*

Name of Public/Private School*

Student 5

Name of Student*

Gender*

Male
Female

Date of Birth*

Grade in 2020/2021*

Name of Public/Private School*

Additional Student Information

If you have more than 5 children, please enter the same information you filled out about in the section below.

Additional Student Information*

Please include Name, Gender, Date of Birth, Grade in 2020/2021, and Name of School. Please use one line per student.

Class Session

* We reserve the right to limit class size.*

Class Session*

Sunday, 9:00 – 10:15 AM, Holy Family Community Center

Medical Concerns / Emergency Contact Info

Medical Concerns*

Please list Child’s Name and any Medical Issues, Allergies, or Learning Disabilities they may have. If None, please write N/A.

Consent*

I agree.

In case of medical emergency, I grant permission to the St. Joseph and St. Mary Staff and volunteers to administer first aid and to secure proper treatment for my child(ren) until I can be reached.

Emergency Contact Name

First Last

Emergency contact person if parent cannot be reached.

Relationship*

Emergency Contact Phone Number*

Photo Permission

I agree.

I/We give permission to use pictures of our children in group photos for use in the bulletin, website and Facebook of St. Joseph and St. Mary Church.

Tuition & Fees

1 Student = $65

2 Students = $80

3+ Students = $95

Confirmation Materials Fee = $40.00 per Student

The Confirmation material Fee is applicable only during the years of sacramental celebrations

Full payment is due at time of registration

Make checks payable to St. Joseph Church