Course Registration Form

Student Registration Form

Classes Start Sunday October 02, 2022
Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Father's Name

First Name Last Name
Mother's Name

First Name Last Name
Father email address
example@example.com
Mother email address 2
example@example.com
Home (Main) Phone Number
Father Mobile
Mother Mobile
Courses
Will the Child receive his/her first communion this year in May 2023 at St. Anthony?

Yes No Other
Special attention

Allergies (Any Kind) Learning skills Medical Alert Other
Please define Medical alert
Please define Learning skills
Please define Allergies:

Did the student receive the Sacraments of Initiation?

Student Registration Form