Course Registration Form

Student Registration Form

Classes Start Sunday October 06, 2024
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Name

First NameLast Name
Mother's Name

First NameLast 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 on May 18, 2025 at St. Anthony?

YesNoOther
Special attention

Allergies (Any Kind)Learning skillsMedical AlertOther
Please define Medical alert
Please define Learning skills
Please define Allergies:

Did the student receive the Sacraments of Initiation?

Student Registration Form