Religious Education Registration Form – St. Joseph Catholic Church

Family Last Name*

Last

Main Contact Phone No.*

Main Mailing Address*

Street Address Address Line 2 City State ZIP Code

Father's Name*

First Last

Father's Phone No*

Prefer Cell # for Emergencies

Father's Email*

Is Father Catholic?*

Yes
No

Sacraments Received*

Baptized
1st Communion
Confirmation
Marriage (Through the Catholic Church)
None

Mother's Name*

First Last Maiden Name

Mother's Phone No*

Prefer Cell # for Emergencies

Mother's Email*

Is Mother Catholic?*

Yes
No

Sacraments Received*

Baptized
1st Communion
Confirmation
Marriage (Through the Catholic Church)
None

Student's Full Name*

First Middle Last

Birth Date*

Grade*

Baptized?*

Yes
No

Baptized at*

Name of Church

Church Address*

Street Address City State / Province / Region ZIP / Postal Code

Sacraments Received

First Communion
Reconciliation
Confirmation

Check all that apply

First Communion Received Where?*

First Reconciliation Received Where?*

Confirmation Received Where?*

Emergency Contact*

First Last

Other than parents

Relation to Student*

ER Contact Phone*

Medical, Allergies, Need, or Other Info.*

Would you like to help?

Catechist
Substitute
Teacher Aid

Pictures & Videos*

YES
NO

Please check Yes or No on whether or not you give Saint Joseph Catholic Church authorization to use your child's picture or video for church and publication use.