RCIA/RCIC Registration Form 2021-2022
Father's Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Mother's Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you registered at Our Lady of the Plains?
Yes
No
Would you like to registered at Our Lady of the Plains?
Yes
No
Emergency Contact
First Name
Last Name
Phone Number
Emergency Contact Relationship to Child
Please list the child/children you would like to enroll in Faith Formation for the year 2021-2022
Child #1
First Name
Last Name
Date of Birth:
Age:
Sacraments Received (Check all that apply):
Baptism
Confirmation
1st Communion
None
Sacraments Needed (Check all that apply):
Baptism
Confirmation
1st Communion
None
Does your child have any learning disabilities, language and or/emotional impairments? If yes, please explain:
Does your child have any allergies and/or medical concerns? If yes, please explain:
Child #2
First Name
Last Name
Date of Birth
Age:
Sacraments Received (Check all that apply):
Baptism
Confirmation
1st Communion
None
Sacraments Needed (Check all that apply):
Baptism
Confirmation
1st Communion
None
Does your child have any learning disabilities, language and or/emotional impairments? If yes, please explain:
Does your child have any allergies and/or medical concerns? If yes, please explain:
Child #3
First Name
Last Name
Date of Birth
Age:
Sacraments Received (Check all that apply):
Baptism
Confirmation
1st Communion
None
Sacraments Needed (Check all that apply):
Baptism
Confirmation
1st Communion
None
Does your child have any learning disabilities, language and or/emotional impairments? If yes, please explain:
Does your child have any allergies and/or medical concerns? If yes, please explain:
Submit
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