• 2020 Religious Education Re-Registration

• Email Address (for all correspondence)*
  example@example.com
• Number of children registering*

• Family Information

• Father's Name
  First Name Last Name
• Mother's Name
  First Name Last Name
• Mother's Maiden Name
• Address
  Street Address

  Street Address Line 2

  City State / Province

  Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country
• Home Phone
  Home Phone
• Email
  example@example.com

• Additional Phone Numbers

• May we text information?
  Yes No
• Father's Cell/Work Phone
  Father's Cell/Work Phone
• Primary
  Primary
• Mother's Cell/Work Phone
  Mother's Cell/Work Phone
• Primary
  Primary
• Emergency Contact
• Relationship
• Emergency Contact Phone
  Emergency Contact Phone

• 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

  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

• 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
  Emergency Contact Phone
• 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

  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

  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

  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

  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

  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

  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

  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 Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country
• Relationship to child
• Home Phone Number
  Home Phone Number
• Cell Phone Number
  Cell Phone Number
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