Form

Name if you have more than one child to register please fill in a separate form.

First Name

Last Name

Name of School attending

Is your Child Baptised?

Yes No

Date of Birth

Date of Baptism

Please note that

If you child was baptised outside this parish, a Baptismal Cert is required. If your child was baptised in St. Mary's Church, Listowel no need for Baptismal Cert as it is on parish records.

Please Attach Baptism Cert

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Name and Full Address of Church Where Child was Baptised

Name of Church where Child was Baptised

Street Address

Street Address Line 2

Town County

Postal / Zip Code

Parent/Guardian Informaion

Parent/Guardian Name

First Name

Last Name

Mobile Number for Main Contact Person

Please enter a valid phone number.

Email Address for Main Contact Person

example@example.com

Address

Street Address

Street Address Line 2

town county

Postal / Zip Code

Please note: Contact mobile number & email are required to enable you to fully participate in the parish preparation programme, and to facilitate the parish maintaing effective communication with you during the year as may be necessay. for the Conifmation Registraion Card to be completed on the day of Confirmation that Card requires "Fathers Name" & Mother's Maiden Name". This is for record purposes only.

Fathers Name

First Name

Last Name

Mothers Maiden (family) Name

First Name

Last Name

Other Parent/Guardian

First Name

Last Name

Phone Number

Please enter a valid phone number

I wish to enroll my child for Confirmation and I will engage with St. Mary's Church Parish Programme of preparation

I Agree

By clicking the box, I hereby Give Permission for photographs and/or Video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website

I Agree

If you are happy for us to retain your name and contact details and keep you up to date about future events & celebrations in our Parish please tick box

I Agree

Thank you from St. Mary's Church

Form

St. Mary's Church, Listowel - Registration Form

Proof Of Baptism

Parent/Guardian Informaion