Religious Education Registration Catholic Cluster
St. John - Sacred Heart - St. James
Parent/Guardian Name
*
Father's Name
Mother's Name
Address
*
Street Address
Apartment or Trailer
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Relationship
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Grade
*
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
How old?
*
Please Select
5
6
7
8
9
10
11
12
13
14
15
16
17
18
What sacrament does your child have?
*
Baptism
First Communion
Confirmation
Any Allergies or Medical Conditions?
*
Yes
No
Please give details about allergies or medical conditions.
Do you have another child to register?
*
Yes
No
Back
Next
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Grade
*
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
How old?
*
Please Select
5
6
7
8
9
10
11
12
13
14
15
16
17
18
What sacrament does your child have?
*
Baptism
First Communion
Confirmation
Any Allergies or Medical Conditions?
*
Yes
No
Please give details of allergies or medical conditions
Do you have another child to register?
*
Yes
No
Back
Next
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Grade
*
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
How old?
*
Please Select
5
6
7
8
9
10
11
12
13
14
15
16
17
18
What sacrament does your child have?
*
Baptism
First Communion
Confirmation
Any Allergies or Medical Conditions?
*
Yes
No
Please give details of allergies or medical conditions
Back
Next
Would you be willing to volunteer in the Religious Education program if needed?
*
Yes
No
I need more information
Have you taken the Virtus (Protecting God's Children) training?
*
Yes
No
Interested in taking it
What is your home Parish?
*
St. John - Dinwiddie
Sacred Heart - Prince George
St. James - Hopewell
Have you registered in the Parish?
*
Yes
No
I, undersigned, agree with the following statements:
*
I am the parent/guardian of the child indicated above.
I am giving my permission to take my child's pictures for classroom projects and post them on the church website.
I agree to support and encourage volunteer catechists by active participating at home and through faithfully fulfilling any responsibilities and expectations for parents throughout the Formation year, to the best of my ability.
Date
-
Month
-
Day
Year
Date
Signature
Submit
Submit
Should be Empty: