Religious Education Registration for 2023-2024 Please fill out one registration form per student Registration for Religious Education Classes 2023-2024 Step 1 of 5 20% Is the family registered in the parish?YesNo, but I would like to registerI'm registered in another parishName of parish you are registered atStudent Name (as it appears in the birth certificate)* First Middle Last Address (where student resides)* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* MM DD YYYY Place of Birth* City/ County State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Age (September 1, 2023)*Grade in 2023-2024*Select OneKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeName of School Where Child will be Attending (2022-2023)*Did your child attend Religious Education Classes last school year (2022-2023) at our parish?*YesNoMy child attended classes at another parishName of Catechist*Name of Parish*If your child will be in K-6th Grade, which catechetical session do you prefer?*English (Sundays 9:30-10:45am)Spanish (Saturdays 9:20-10:35am)HomeschoolIf your child will be in 7-12th Grade, which catechetical session do you prefer?*Mondays: 7:00-8:15pmHomeschool SACRAMENTAL INFORMATIONBAPTISM - Has the child received Baptism?*Select OneYesNoDate of Baptism* Date Format: MM slash DD slash YYYY Name of Parish of Baptism*Location of Parish of Baptism (City/State)*FIRST COMMUNION - Has the child received First Communion?*Select OneYesNoDate of First Communion Date Format: MM slash DD slash YYYY Name of Parish of First Communion*CONFIRMATION - Has the child received Confirmation?*Select OneYesNoDate of Confirmation Date Format: MM slash DD slash YYYY Name of Parish of Confirmation*INFORMATION ABOUT THE STUDENTPlease mention any special or medical needs(Learning or physical disabilities, ADHD, hearing/vision impaired, etc.)Allergies Parent InformationFATHERFather's Full Name (as it appears in Child's Birth Certificate)*If the father does not appear in the child's birth certificate, write "N/A"Telephone #*If the father is not present in the child's life, write "000-000-0000"Email Civil Status*Select OneSingleMarried in the CHURCH to the child's motherMarried CIVILLY to the child's motherLiving with my partner (not yet married)SeparatedDivorcedWidowMarried to a different person (other than the child's mother)I'm not sure, I would like to talk to a priestN/AIf the father is not present in the child's life, select "N/A"Language(s) Spoken (select all that apply) English Spanish Amharic French Italian Portuguese Tagalog Vietnamese Other ReligionDoes the father reside in the same address as the student?*Select OneYesNoN/AAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code MOTHERMother's Full Name*If mother is not present in the child's life, write "N/A"Telephone #*If mother is not present in the child's life, write "000-000-0000"Email Civil Status*Select OneSingleMarried in the CHURCH to the child's motherMarried CIVILLY to the child's motherLiving with my partner (not yet married)SeparatedDivorcedWidowMarried with a different personI'm not sure, I would like to talk to a priestN/AIf mother is not present in the child's life, select "N/A"Language(s) Spoken (select all that apply) English Spanish Amharic French Italian Portuguese Tagalog Vietnamese Other ReligionDoes the mother reside in the same address as the student?*Select OneYesNoN/AAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CustodyLegal Custody*Select OneBoth parents have custody without restrictionsBoth parents have custody with restistrictionsParents are separated and have joint custody, no restrictionsOnly the mother has full custodyOnly the father has full custodyNone of the above, I would like to explainName of individuals who have legal custody of the child. Please also add relationship to the child (for example: grandmother, other)List Restrictions/ Court Orders*Name of siblings that will also attend Religious Education Classes in 2022-2023Notice: you will have to fill out a separate form to register additional childrenVolunteer in Our Program Check here if you wish to volunteer in the Religious Education Program. Volunteer Opportunities: Catechist, Assistant Catechist, Hallway Monitor, Office Staff (during the session) How would you like to volunteer? Catechist Catechist Assistant Hallway Monitor Parking Lot- Security Religious Education Office during my child's class Religious Education Office during the weekday morning/afternoon Other Emergency ContactsList those, over the age of 18, allowed to drop-off and pick-up your child any time during the year, and whom we may contact in the case of an emergency (other than mom or dad)Name (Emergency Contact 1) First Last PhoneRelationship to Student (Ex: aunt, brother, nanny, family friend, etc.)Name (Emergency Contact 2) First Last PhoneRelationship to Student (Ex: aunt, brother, nanny, family friend, etc.)Medical CareIf the need arises, I give permission for my child to receive emergency medical care while participating in the Religious Education Program*YesNo Documents to SubmitHere you may submit a picture or PDF of your child's birth certificate, baptism certificate, or any other important documents you think are important for our office to have such as court orders, etc. Birth CertificateBaptismal CertificateFirst Communion CertificateOther DocumentsPaymentone student: $80; two students: $160; three or more students: $200Method of paymentI would like to pay online with a credit cardI would like to mail a checkI would like to set up an appointment to pay by cash in the officeI would like a payment plan to pay the feeName & Signature of Person Submitting RegistrationName of Person Registering Student* First Last Email of person registering the student* Signature*All information given in this form is true.Date* Date Format: MM slash DD slash YYYY CAPTCHA
