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

Name

This field is for validation purposes and should be left unchanged.