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  • Student Information
    • First Name REQUIRED Please fill out this field. Please enter valid data.

      Last Name REQUIRED Please fill out this field. Please enter valid data.
    • Date of Birth REQUIRED Please fill out this field. Please enter a date.
    • Student Lives With REQUIRED (Select One) Both Parents Mother Father Other Please fill out this field.
    • School attending in Sept. 2019 REQUIRED Please fill out this field. Please enter valid data.
    • Grade (Sept. 2019) REQUIRED Please fill out this field. Please enter valid data.
    • Church of Baptism (for new registrations) Please send or email copy of baptismal certificate. Please enter valid data.
    • Date of Baptism (for new registrations) Please enter a date.
  • 2nd Student Information
    • First Name REQUIRED Please fill out this field. Please enter valid data.

      Last Name REQUIRED Please fill out this field. Please enter valid data.
    • Date of Birth REQUIRED Please fill out this field. Please enter a date.
    • Student Lives With REQUIRED (Select One) Both Parents Mother Father Other Please fill out this field.
    • School attending in Sept. 2019 REQUIRED Please fill out this field. Please enter valid data.
    • Grade (Sept. 2019) REQUIRED Please fill out this field. Please enter valid data.
    • Church of Baptism (for new registrations) Please send or email copy of baptismal certificate. Please enter valid data.
    • Date of Baptism (for new registrations) Please enter a date.
  • 3rd Student Information
    • First Name REQUIRED Please fill out this field. Please enter valid data.

      Last Name REQUIRED Please fill out this field. Please enter valid data.
    • Date of Birth REQUIRED Please fill out this field. Please enter a date.
    • Student Lives With REQUIRED (Select One) Both Parents Mother Father Other Please fill out this field.
    • School attending in Sept. 2019 REQUIRED Please fill out this field. Please enter valid data.
    • Grade (Sept. 2019) REQUIRED Please fill out this field. Please enter valid data.
    • Church of Baptism (for new registrations) Please send or email copy of baptismal certificate. Please enter valid data.
    • Date of Baptism (for new registrations) Please enter a date.
  • Parents
    • Family Situation None First Marriage Single (unwed) Widowed Separated Divorced Remarried
    • First Name REQUIRED Please fill out this field. Please enter valid data.

      Last Name REQUIRED Please fill out this field. Please enter valid data.
    • First Name REQUIRED Please fill out this field. Please enter valid data.

      Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Student Mailing Address. c/o:
    • Title None Mr. Mrs. Mr. & Mrs. Mr. & Ms. Ms. Miss
    • First Name REQUIRED Please fill out this field. Please enter valid data.

      Last Name REQUIRED Please fill out this field. Please enter valid data.
    • Street Please enter valid data.
    • City REQUIRED Please fill out this field. Please enter valid data.

      State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

      Zip REQUIRED Please fill out this field. Please enter a zip code.
    • Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.
    • Mobile Phone Number or Emergency REQUIRED Please fill out this field. Please enter a phone number.
    • Email of Adult receiving information Please enter an email address.
  • Other Info (incl. name if more than one child)
    • Allergies, daily medication, important medical information:
    • Special programs or services your child is involved in at school:
    • Any other information we should know:
    • Parent comments or information (travel restrictions, carpools, shared custody, etc.):
    • I give permission to include my child(red) in activity photos on our website Yes No
    • I am available to help in the following way(s) in order to enhance our religious ed. program Teach a small class Help with Snacks/socials Help organize Souperbowl or other service programs Organize Giving Tree Help organize Easter Egg Hunt Help with general organization Other
    • Other ways to help

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