Child’s Name: _____________________________________________________________ Grade: ______

Address: ________________________________________________________________________________

Street/Apt. Number City Zip Code

Home Phone: _____________________________ School _______________________________________

Age: ______ Date of Birth: _____________________ Place of Birth _____________________________

Father’s Name: _______________________________________ Work Phone: ______________________

Mother’s Name: ______________________________________ Work Phone: ______________________

Mother’s Full Maiden Name: ____________________________________________________

If your child is at a babysitter’s after school, please give the name and phone number below:

Person’s Name: _______________________________________ Phone Number: ___________________

Please Note: Children/Youth preparing for First Communion/Confirmation need to present a baptismal certificate at the time of registration.

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Sacramental Data: Please give the following sacramental information for your child on the space below.

Yes Parish, city, state, country (if other than U.S.) No

Baptism ____ ____________________________________________________ ____

First Communion ____ ____________________________________________________ ____

First Reconciliation ____ ____________________________________________________ ____

Confirmation ____ ____________________________________________________ ____

Does your child require preparation for Baptism, Confirmation or First Communion this year? If yes, which sacrament(s)? ____________________________________ No. of years completed in Religious Ed.: ____

Please Note: There is a two-year preparation period prior to celebrating First Communion or Confirmation.

Grade 2 is minimum age for First Communion; Grade 8, for Confirmation.

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Please list below any special custody arrangements you have for your child and submit a copy of the custody rights and any other applicable legal document(s) to the Catechetical Office so that we can comply with them. These will be kept on file in the office.

In case of an emergency, we will call 911 first, then the parents/guardians. Below, please name two persons who can be called if parents/guardians cannot be reached:

1. Name __________________________________________ Phone ______________________________

Address ____________________________________________________________________________

2. Name __________________________________________ Phone ______________________________

Address ___________________________________________________________________________

List below any allergies or health conditions your child has and that we should be made aware of.

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Parent/Guardian’s Signature: _______________________________________ Date __________________

Day Phone: __________________ Eve Phone: __________________ e-mail: _______________________

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