St. Mary's Religious Education Registration 2023-2024
Family Last Name
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Mother's Name
First Name
Last Name
Mother's Phone
Please enter a valid phone number.
Format: (000) 000-0000.
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Father's Name
First Name
Last Name
Father's Phone
Please enter a valid phone number.
Format: (000) 000-0000.
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Primary Email (Communication will primarily be through email)
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child Resides Primarily With:
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Emergency Contact Name (May not be a parent)
First Name
Last Name
Emergency Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship
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Medical Release: In the event that I cannot be reached to make arrangements, I hereby give consent to St. Mary's Catholic Church to contact the named physician and, if necessary, transport my child to a clinic or hospital.
Please Select
I Consent
Doctor's Name
First Name
Last Name
Doctor's Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Insurance Company and Policy Number
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Permission to Use Pictures: I hereby give St. Mary's Catholic Church permission to publish pictures of my child(ren) on the parish website, in parish publications, or local/social media.
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I Consent
I Do Not Consent
I understand my responsibility as a parent to attend all RE activities, Family Faith classes, events, and Sacrament preparations. I hereby verify that all the information in this form is accurate to the best of my knowledge, and that selecting "I Consent" serves as an electronic signature.
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I Consent
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Child Name
First Name
Last Name
Baptism (Year and Parish) and First Communion (Year and Parish)
Child's Date of Birth
-
Month
-
Day
Year
Date
Grade in School (2023/2024)
Sex
Male
Female
Allergies, Special Needs, Medications, or Additional Comments
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Child 2
Child Name
First Name
Last Name
Baptism (Year and Parish) and First Communion (Year and Parish)
Date of Birth
-
Month
-
Day
Year
Date
Grade in School (2023/2024)
Sex
Male
Female
Allergies, Special Needs, Medications, or Additional Comments
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Child 3
Child Name
First Name
Last Name
Baptism (Year and Parish) and First Communion (Year and Parish)
Date of Birth
-
Month
-
Day
Year
Date
Grade in School (2023-2024)
Sex
Male
Female
Allergies, Special Needs, Medications, or Additional Comments
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Child 4
Child Name
First Name
Last Name
Baptism (Year and Parish) and First Communion (Year and Parish)
Date of Birth
-
Month
-
Day
Year
Date
Grade in School (2023-2024)
Sex
Male
Female
Allergies, Special Needs, Medications, or Additional Comments
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If you have more than 4 children, please contact the Office of Catechesis and Evangelization at oce@stmarysbellevue.com and we will get you registered! Thank you!
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