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Registration Form - 1st Reconciliation/1st Eucharist

- Faith Formation
  - EDUCATION
    
    Parish School of Religion
    OCIA
    Vacation Bible School
    Resources
  - SACRAMENTAL PREPARATION
    
    First Reconciliation & First Communion
    Confirmation
  - RELIGIOUS EDUCATION REGISTRATION
    
    Registration Form - 1st Reconciliation/1st Eucharist
  - OUR SCHOOLS
    
    Holy Family Pre-K3
    Holy Family School

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- Please provide the complete legal names exactly as they appear on the birth certificate. Please carefully fill in all required information to ensure accuracy.
- Registering for: REQUIRED Please fill out this field.
- 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 valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- City & State of Birth Please enter valid data.
- Date of Baptism REQUIRED Please fill out this field. Please enter a date.
- Church, City & State of Baptism Please enter valid data.
- Grade Level Entering this Fall REQUIRED Please fill out this field.
- School Registered Please enter valid data.
- List grade and elementary schools attended thus far
- List name of church parish & grade levels student attended Parish School of Religion
- Parent/Guardian Information
  
  Select
  
  Father's Name Please enter valid data.
  
  Father's Address Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Work Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Father's Religion Please enter valid data.
  
  Father's Church Parish Please enter valid data.
  
  Mother's Name Please enter valid data.
  
  Mother's Address (if different from Father's) Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Work Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mother's Religion Please enter valid data.
  
  Mother's Church Parish Please enter valid data.
  
  Guardian's Name Please enter valid data.
  
  Guardian's Address Please enter valid data.
  
  Guardian's Home Phone Maximum 20 characters Please enter a phone number.
  
  Guardian's Work Phone Maximum 20 characters Please enter a phone number.
  
  Guardian's Cell Phone Maximum 20 characters Please enter a phone number.
  
  Guardian's Email Address Please enter an email address.
  
  Guardian's Religion Please enter valid data.
  
  Guardian's Church Parish Please enter valid data.
- Emergency Medical Treatment
  
  In an event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. In the event of an emergency, if you are unable to reach me at the above number, contact:
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Doctor REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Health Plan Carrier Please enter valid data.
  
  Policy Number Please enter valid data.
- Send Form Confirmation Email to: REQUIRED Please fill out this field. Please enter an email address.
- To complete your registration, your signature on the above information is required. You will receive your printed form at the Registration Meeting to review and sign.
  
  You may pay the registration fee by selecting the "PAY NOW" button below, or you can select "PAY LATER" and bring a check to the meeting.
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Registration Form - 1st Reconciliation/1st Eucharist

Please provide the complete legal names exactly as they appear on the birth certificate. Please carefully fill in all required information to ensure accuracy.

In an event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. In the event of an emergency, if you are unable to reach me at the above number, contact: