Religious Education/Youth Group Registration Form

Registration Form for 2024-2025

Fill out the form carefully for registration for Religious Education and Youth Group
Student Information
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Primary Language spoken at home*
Has your child been Baptized? (Please provide a copy of Baptismal Certificate)*
Class:*
Grade for 2024-2025 (Next) School Year:*
Family Information
Father's Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Father's Phone Number*
Father's E-mail*
example@example.com
Mother's Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Mother's Phone Number*
Mothers's E-mail*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information

This person is NOT A PARENT. Emergency Contact is someone who we can contact in an emergency in case we cannot get ahold of the parents.
Emergency Contact Information (SHOULD NOT BE A PARENT)*

First NameMiddle NameLast Name
Emergency Contact Phone Number (Not the same number as Parents)*
Relationship to Student*
Additional Comments
File Upload: Baptismal Certificate

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Please read the following carefully. I agree to the following::*
Signature*

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Registration Form for 2024-2025