2021 Religious Education Registration
Email Address (for all correspondence)*
example@example.com
Number of children registering*
Father's Information
Father's Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Email
example@example.com
Marital Status
Select One
Select One
Single
Married
Divorced
Widowed
Are you Catholic?
Yes
No
Back
Next
Mother's Information
Mother's Name
First Name
Last Name
Mother's Maiden Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Email
example@example.com
Marital Status
Select one
Select One
Single
Married
Divorced
Widowed
Marital Status
Are you Catholic?
Yes
No
Back
Next
Student One Information
Student's Name
Gender
Male
Female
Catholic?
Yes
No
Grade In School
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Sacrament Information
Baptism
Yes
No
Baptism Date
Year only
Baptism - Church Name
Baptism - Location
First time registration for each child: Please provide a Baptismal Certificate if your child was not baptized at a St. Bernard & St. Stanislaus Parish.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Reconciliation
Yes
No
Reconciliation Date
Year only
Reconciliation - Church Name
Reconciliation - Location
First Eucharist
Yes
No
First Eucharist Date
Year only
First Eucharist - Church Name
First Eucharist - Location
Confirmation
Yes
No
Confirmation Date
Year only
Confirmation - Church Name
Confirmation - Location
Back
Next
Medical Information - Student One
Does your son/ daughter have any medical problems, allergies or physical limitations that we should know about ?
Yes
No
If yes, please explain
Doctor's Name
Doctor's Phone Number
Doctor's Phone Number
Hospital Preference
In case of a medical emergency, I give Bernard of Clairvaux and St. Stanislaus Kostka authorization to take my child for emergency medical care.
Yes
No
Add another child?
*
Yes
No
Back
Next
Student Two Information
Student's Name
Gender
Male
Female
Catholic?
Yes
No
Grade In School
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Sacrament Information
Baptism
Yes
No
Baptism Date
Year only
Baptism - Church Name
Baptism - Location
First time registration for each child: Please provide a Baptismal Certificate if your child was not baptized at a St. Bernard & St. Stanislaus Parish.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Reconciliation
Yes
No
Reconciliation Date
Year only
Reconciliation - Church Name
Reconciliation - Location
First Eucharist
Yes
No
First Eucharist Date
Year only
First Eucharist - Church Name
First Eucharist - Location
Confirmation
Yes
No
Confirmation Date
Year only
Confirmation - Church Name
Confirmation - Location
Back
Next
Medical Information - Student Two
Does your son/ daughter have any medical problems, allergies or physical limitations that we should know about ?
Yes
No
If yes, please explain
Doctor's Name
Doctor's Phone Number
Doctor's Phone Number
Hospital Preference
In case of a medical emergency, I give Bernard of Clairvaux and St. Stanislaus Kostka authorization to take my child for emergency medical care.
Yes
No
Add another child?
*
Yes
No
Back
Next
Student Three Information
Student's Name
Gender
Male
Female
Catholic?
Yes
No
Grade In School
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Sacrament Information
Baptism
Yes
No
Baptism Date
Year only
Baptism - Church Name
Baptism - Location
First time registration for each child: Please provide a Baptismal Certificate if your child was not baptized at a St. Bernard & St. Stanislaus Parish.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Reconciliation
Yes
No
Reconciliation Date
Year only
Reconciliation - Church Name
Reconciliation - Location
First Eucharist
Yes
No
First Eucharist Date
Year only
First Eucharist - Church Name
First Eucharist - Location
Confirmation
Yes
No
Confirmation Date
Year only
Confirmation - Church Name
Confirmation - Location
Back
Next
Medical Information - Student Three
Does your son/ daughter have any medical problems, allergies or physical limitations that we should know about ?
Yes
No
If yes, please explain
Doctor's Name
Doctor's Phone Number
Doctor's Phone Number
Hospital Preference
In case of a medical emergency, I give Bernard of Clairvaux and St. Stanislaus Kostka authorization to take my child for emergency medical care.
Yes
No
Add another child?
*
Yes
No
Back
Next
Student Four Information
Student's Name
Gender
Male
Female
Catholic?
Yes
No
Grade In School
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Sacrament Information
Baptism
Yes
No
Baptism Date
Year only
Baptism - Church Name
Baptism - Location
First time registration for each child: Please provide a Baptismal Certificate if your child was not baptized at a St. Bernard & St. Stanislaus Parish.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Reconciliation
Yes
No
Reconciliation Date
Year only
Reconciliation - Church Name
Reconciliation - Location
First Eucharist
Yes
No
First Eucharist Date
Year only
First Eucharist - Church Name
First Eucharist - Location
Confirmation
Yes
No
Confirmation Date
Year only
Confirmation - Church Name
Confirmation - Location
Back
Next
Medical Information - Student Four
Does your son/ daughter have any medical problems, allergies or physical limitations that we should know about ?
Yes
No
If yes, please explain
Doctor's Name
Doctor's Phone Number
Doctor's Phone Number
Hospital Preference
In case of a medical emergency, I give Bernard of Clairvaux and St. Stanislaus Kostka authorization to take my child for emergency medical care.
Yes
No
Add another child?
*
Yes
No
Back
Next
Student Five Information
Student's Name
Gender
Male
Female
Catholic?
Yes
No
Grade In School
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Sacrament Information
Baptism
Yes
No
Baptism Date
Year only
Baptism - Church Name
Baptism - Location
First time registration for each child: Please provide a Baptismal Certificate if your child was not baptized at a St. Bernard & St. Stanislaus Parish.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Reconciliation
Yes
No
Reconciliation Date
Year only
Reconciliation - Church Name
Reconciliation - Location
First Eucharist
Yes
No
First Eucharist Date
Year only
First Eucharist - Church Name
First Eucharist - Location
Confirmation
Yes
No
Confirmation Date
Year only
Confirmation - Church Name
Confirmation - Location
Back
Next
Medical Information - Student Five
Does your son/ daughter have any medical problems, allergies or physical limitations that we should know about ?
Yes
No
If yes, please explain
Doctor's Name
Doctor's Phone Number
Doctor's Phone Number
Hospital Preference
In case of a medical emergency, I give Bernard of Clairvaux and St. Stanislaus Kostka authorization to take my child for emergency medical care.
Yes
No
Add another child?
*
Yes
No
Back
Next
Student Six Information
Student's Name
Gender
Male
Female
Catholic?
Yes
No
Grade In School
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Sacrament Information
Baptism
Yes
No
Baptism Date
Year only
Baptism - Church Name
Baptism - Location
First time registration for each child: Please provide a Baptismal Certificate if your child was not baptized at a St. Bernard & St. Stanislaus Parish.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Reconciliation
Yes
No
Reconciliation Date
Year only
Reconciliation - Church Name
Reconciliation - Location
First Eucharist
Yes
No
First Eucharist Date
Year only
First Eucharist - Church Name
First Eucharist - Location
Confirmation
Yes
No
Confirmation Date
Year only
Confirmation - Church Name
Confirmation - Location
Back
Next
Medical Information - Student Six
Does your son/ daughter have any medical problems, allergies or physical limitations that we should know about ?
Yes
No
If yes, please explain
Doctor's Name
Doctor's Phone Number
Doctor's Phone Number
Hospital Preference
In case of a medical emergency, I give Bernard of Clairvaux and St. Stanislaus Kostka authorization to take my child for emergency medical care.
Yes
No
Add another child?
*
Yes
No
Back
Next
Student Seven Information
Student's Name
Gender
Male
Female
Catholic?
Yes
No
Grade In School
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Sacrament Information
Baptism
Yes
No
Baptism Date
Year only
Baptism - Church Name
Baptism - Location
First time registration for each child: Please provide a Baptismal Certificate if your child was not baptized at a St. Bernard & St. Stanislaus Parish.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Reconciliation
Yes
No
Reconciliation Date
Year only
Reconciliation - Church Name
Reconciliation - Location
First Eucharist
Yes
No
First Eucharist Date
Year only
First Eucharist - Church Name
First Eucharist - Location
Confirmation
Yes
No
Confirmation Date
Year only
Confirmation - Church Name
Confirmation - Location
Back
Next
Medical Information - Student Seven
Does your son/ daughter have any medical problems, allergies or physical limitations that we should know about ?
Yes
No
If yes, please explain
Doctor's Name
Doctor's Phone Number
Doctor's Phone Number
Hospital Preference
In case of a medical emergency, I give Bernard of Clairvaux and St. Stanislaus Kostka authorization to take my child for emergency medical care.
Yes
No
Add another child?
Yes
No
Back
Next
Student Eight Information
Student's Name
Gender
Male
Female
Catholic?
Yes
No
Grade In School
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Sacrament Information
Baptism
Yes
No
Baptism Date
Year only
Baptism - Church Name
Baptism - Location
First time registration for each child: Please provide a Baptismal Certificate if your child was not baptized at a St. Bernard & St. Stanislaus Parish.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Reconciliation
Yes
No
Reconciliation Date
Year only
Reconciliation - Church Name
Reconciliation - Location
First Eucharist
Yes
No
First Eucharist Date
Year only
First Eucharist - Church Name
First Eucharist - Location
Confirmation
Yes
No
Confirmation Date
Year only
Confirmation - Church Name
Confirmation - Location
Back
Next
Medical Information - Student Eight
Does your son/ daughter have any medical problems, allergies or physical limitations that we should know about ?
Yes
No
If yes, please explain
Doctor's Name
Doctor's Phone Number
Doctor's Phone Number
Hospital Preference
In case of a medical emergency, I give Bernard of Clairvaux and St. Stanislaus Kostka authorization to take my child for emergency medical care.
Yes
No
Back
Next
Emergency Contact Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to child
Home Phone Number
Home Phone Number
Cell Phone Number
Cell Phone Number
Back
Next
Thank you for registering your child/children for St. Bernard of Clairvaux and St. Stanislaus Kostka Church Religious Education classes.
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