CLASS ENROLLMENT

St. Patrick Parish Religious Education

2021-2022 Registration form for Baptized High School Students
Contact Name *

First Name Last Name
Contact Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Student Information
Student's First Name *
Student's Last Name *
Student's Date of Birth *

Month Day Year
Student's Place of Birth *
City and State/Province (Country if not US)
School currently attending *
Grade *
Family Information
Mother's Information *

First Name Last Name
Mother's Maiden Name *
Father's Information

First Name Last Name
Guardian name if not parent
Guardian's relationship to child
Student's Sacrament Information (Please check yes if student has received the sacrament and no if they have not received the sacrament)
Baptized *

yes no
First Holy Communion *

yes no
Sacrament of Reconciliation *

yes no
Sacrament Preparation *
Student's Baptism Information
Date of Baptism *

Month Day Year
Church of Baptism *
Church Information if checked other in above tab

Church Name

Church Address

City State / Province

Postal / Zip Code Country
Attach copy of Baptism Certificate
Student's First Holy Communion Information
Church of First Holy Communion
Church Information if checked other

Church Name

Church Address

City State / Province

Postal / Zip Code Country
Student's First Reconciliation Information
Church of First Reconciliation
Church Address
Should be Empty:

St. Patrick Parish Religious Education