Parent / Guardian #1:
First Name
Last Name
Parent / Guardian #2:
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Email Address:
example@example.com
Are you willing to volunteer in our Faith Formation program?
Yes, please email me more information!
No, not at this time.
Is your family registered with Immaculate Conception Parish?
Yes
No
If no, what parish is your family registered with?
If yes, what Mass does your family usually attend?
In case of emergency, please provide the name, phone number, and relationship status of someone who lives in the area, other than a parent, that your child(ren) can be released to:
First Child's Name:
First Name
Last Name
Academic Grade for upcoming school year:
Age:
Date of Birth:
-
Month
-
Day
Year
Date
Gender:
Male
Female
Sacraments Completed:
Baptism
First Reconciliation
Holy Eucharist
Confirmation
Date and Parish of Baptism:
Please tell us a little bit about your child.
Second Child's Name:
First Name
Last Name
Academic Grade for upcoming school year:
Age:
Date of Birth:
-
Month
-
Day
Year
Date
Gender:
Male
Female
Sacraments Completed:
Baptism
First Reconciliation
Holy Eucharist
Confirmation
Date and Parish of Baptism:
Please tell us a little bit about your child.
Third Child's Name:
First Name
Last Name
Academic Grade for upcoming school year:
Age:
Date of Birth:
-
Month
-
Day
Year
Date
Gender:
Male
Female
Sacraments Completed:
Baptism
First Reconciliation
Holy Eucharist
Confirmation
Date and Parish of Baptism:
Please tell us a little bit about your child.
Fourth Child's Name:
First Name
Last Name
Academic Grade for upcoming school year:
Age:
Date of Birth:
-
Month
-
Day
Year
Date
Gender:
Male
Female
Sacraments Completed:
Baptism
First Reconciliation
Holy Eucharist
Confirmation
Date and Parish of Baptism:
Please tell us a little bit about your child.
5th Child's Name:
First Name
Last Name
Academic Grade for upcoming school year:
Age:
Date of Birth:
-
Month
-
Day
Year
Date
Gender:
Male
Female
Sacraments Completed:
Baptism
First Reconciliation
Holy Eucharist
Confirmation
Date and Parish of Baptism:
Please tell us a little bit about your child.
Media Release: I give permission for photographs or video of my child(ren) to be used in publications, websites, brochures, flyers, and social networking from time to time by the Parish.
*
Yes, I give persmission.
No, I do not give permission.
Safe Environment: I give permission for my child(ren) to attend the Safe Environment discussion offered at Immaculate Conception Parish. I understand that it is my right and responsibility as a parent under the guidelines of the Catholic Church to do any such instruction myself.
Yes, I give permission.
No, I do not give permission.
Total Amount Due:
The registration fee per child is $35. Sacramental classes are an additional $25 per student. Please send your check in to the Parish Office by September 18th, 2022.
Submit
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