Youth Ministry Registration
Fill out the form carefully for registration
Mother Full Name
First Name
Last Name
Mother Maiden Name
Mother Email
example@example.com
Mother Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Father Full Name
First Name
Last Name
Father Email
example@example.com
Father Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
Not a parent
Emergency Contact Number
Format: (000) 000-0000.
Is this your first year of Faith Formation at St. Rita?
Yes
No
Registered Parishioner at
Please indicate your frequency of Mass attendance as a family (parent & child together)
Please Select
Daily
Every Week
Twice a month
Once a month
Rarely
Easter/Christmas Only
According to St. Rita policy, all children are required to be signed out by an approved person. Please list any persons who have permission to release your child from our care.
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Child # 1 - Student Name
*
First Name
Middle Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Age
Grade
Current School
Sacraments this year
Please Select
None
Baptism
Reconciliation
Eucharist
Confirmation
Baptized?
Yes
No
Church of Baptism
Received First Eucharist?
Yes
No
Church of First Communion
Received Confirmation?
Yes
No
Church of Confirmation
Register another Child?
Yes
No
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Child #2 - Student Name
First Name
Middle Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Age
Grade
Current School
Sacraments this year
Please Select
None
Baptism
Reconciliation
Eucharist
Confirmation
Baptized?
Yes
No
Church of Baptism
Received First Eucharist?
Yes
No
Church of First Communion
Received Confirmation?
Yes
No
Church of Confirmation
Register another Child?
Yes
No
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Child #3 - Student Name
First Name
Middle Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Age
Grade
Current School
Sacraments this year
Please Select
None
Baptism
Reconciliation
Eucharist
Confirmation
Baptized?
Yes
No
Church of Baptism
Received First Eucharist?
Yes
No
Church of First Communion
Received Confirmation?
Yes
No
Church of Confirmation
Register another Child?
Yes
No
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Next
Child #4 - Student Name
First Name
Middle Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Age
Grade
Current School
Sacraments this year
Please Select
None
Baptism
Reconciliation
Eucharist
Confirmation
Baptized?
Yes
No
Church of Baptism
Received First Eucharist?
Yes
No
Church of First Communion
Received Confirmation?
Yes
No
Church of Confirmation
Register another Child?
Yes
No
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Next
Child #5 - Student Name
First Name
Middle Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Age
Grade
Current School
Sacraments this year
Please Select
None
Baptism
Reconciliation
Eucharist
Confirmation
Baptized?
Yes
No
Church of Baptism
Received First Eucharist?
Yes
No
Church of First Communion
Received Confirmation?
Yes
No
Church of Confirmation
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Would you like to prepay?
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( X )
How many students?
$30.00
$
30.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
How many students making a sacrament this year?
$20.00
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
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Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
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