IMMACULATE CONCEPTION PARISH Rel. Ed. Registration Form 2020-2021
Fill out the form carefully for registration
Child Name/Nombre del Niño o Niña
*
First Name/Nombre
Middle Name
Last Name/Apellido
Gender/Genero
*
Please Select
Male/Varon
Female/Hembra
Birth Date/Fecha de nacimiento
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
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12
13
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30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
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1982
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1935
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Age
School Grade
Please Select
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Sacrament Received
*
None/Ningun Sacramento
Baptism/Bautismo
Eucharist/Comunion
Confirmation/Cresima
Was the child baptized at IMMACULATE CONCEPTION in Revere?/Fue el niño bautizado en IMMACULATE CONCEPTION in Revere?
*
YES/SI
NO/NO
Church of Baptism
*
Iglesia del Bautismo
Date of Baptism
*
-
Month
-
Day
Year
Date
Church of Eucharist
Iglesia de la Comunion
Date of Communion
-
Month
-
Day
Year
Date
Upload here Copy of the Baptism Certificate/Copia del certificado del Bautismo
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Or take a picture of the Baptism Certificate/Toma una foto del certificado del Baut.
Select language for Rel. Ed./Seleccione el idioma para Rel. Ed.
*
English
Spanish
Select Grade for English Rel. Ed.
Grade 1- First year Rel. Ed.
Grade 2 - Second Year Rel. Ed.
Elena Martinez - Communion
Confirmation 1
Confirmation 2
Seleccione el grado para Spanish CCD
Grade 1- First year Rel. Ed.
Grade 2 - Second Year Rel. Ed.
Note/Special needs (Medical, Learning Disabilities, Physical Disabilities, etc.)
Alergias, enfermedad de riesgo
Emergency Contact/Persona de contacto en caso de emergencia
*
Name/Nombre
Emergency Contact/Persona de contacto en caso de emergencia
*
Number/Tel. celular
Parents info
Informacion acerca de la familia
Father's information/Informacion acerca del padre
*
Father's First Name/Nombre
Middle Name
Father Last Name/Apellido
Mother's information/Informacion acerca de la madre
*
Mother's First Name/Nombre
Middle Name
Mother's Maiden Name/Apellido de soltera
Address/Direccion
*
Street Address/Numero, Calle, Apartamento
Street Address Line 2
City/Ciudad
State/Estado
Zip Code/Codigo Postal
Email
example@example.com
Father's Cell/Celular del Padre
*
Mother's Cell/Celular de la Madre
*
Both Parents Catholic?/Son los padres Catolico?
Please Select
Yes/Si
No/No
Payment Methods
*
Cash $75.00 per student
Check $75.00 per student
Credit card $77.06 per student
PAY HERE WITH YOUR CREDIT CARD Registration Fee ($75.00+$2.06 using CC)
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Registration Fee Rel. Ed.
Credit Card
Payed
YES
NO
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