Religious Education Form English Print R.E. Form English PrintDownload CAPTCHAFamily InformationParents' Names* Last Name Dad’s Name Mom’s Name Mom’s Maiden Name Home Address* Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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:* Both Parents Mother Father Guardian/Relation Other Guardian/Other Person's Name* First Last Guardian/Other Person's Phone*Student InformationOnly for Returning FamiliesNumber of Students to Enter*Student 1Name of Student* Gender* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade in 2020/2021* Name of Public/Private School* Student 2Name of Student* Gender* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade in 2020/2021* Name of Public/Private School* Student 3Name of Student* Gender* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade in 2020/2021* Name of Public/Private School* Student 4Name of Student* Gender* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade in 2020/2021* Name of Public/Private School* Student 5Name of Student* Gender* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade in 2020/2021* Name of Public/Private School* Additional Student InformationIf 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 InfoMedical 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 PermissionPhoto 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 & Fees1 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 ChurchPhoneThis field is for validation purposes and should be left unchanged.
