Family Last Name* Last Main Contact Phone No.*Main Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Father's Name* First Last Father's Phone No*Prefer Cell # for EmergenciesFather'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 EmergenciesMother'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* MM slash DD slash YYYY Grade*KindergartenFirstSecondThirdFourthFifthSixthSeventhEighthNinthTenthEleventhTwelfthBaptized?* 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 applyFirst Communion Received Where?* First Reconciliation Received Where?* Confirmation Received Where?* Emergency Contact* First Last Other than parentsRelation 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.