Form

Form
St. Mary's Church, Listowel - Registration Form

Confirmation
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?

YesNo
Date of Birth

DayMonthYear
Date of Baptism

DayMonthYear
Proof 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

Cancelof
Name and Full Address of Church Where Child was Baptised
Name of Church where Child was Baptised

Street Address

Street Address Line 2

TownCounty

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

towncounty

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
Should be Empty:

Form

St. Mary's Church, Listowel - Registration Form

Proof Of Baptism

Parent/Guardian Informaion