Religious Education Registration Form

(For Children K - 8 Only ) Which day will your child attend the program?*

Name of Student*

Street Address*

City*

State*

Zip*

Telephone* - -

E-mail Address*

Date of Birth*

Place of Birth *

Current Grade and School Attending*

Mother's Maiden Name*

Father's Name*

Family Status* Child living with both parents Child living with one parent

If child living with one parent select: Mother Father

Baptism Date*

Baptism Church and Address

Reconciliation and Penance Date

Reconciliation Church and Address

First Holy Communion Date

Communion Church and Address

Confirmation Date

Confirmation Church and Address

Is your family a parishioner of St. Joseph?* Yes No

If no, please indicate what church you are registered in

Please indicate any learning disabilities or food allergies, type NONE if there aren't any.*

Emergency Information during class time*

Please list name of contact, relationship and phone number

Consent to use photos/videos taken of your child in class for publicity, promotional, or educational purposes* Yes No

Signature of Parent or Legal Guardian*