StAnne-Arv Youth Reconciliation Registration

YOUTH RECONCILIATION REGISTRATION
Children in 2^nd grade or above who wish to prepare for the Sacrament of Reconciliation must have at least one year of formal Faith Formation in a parish program or Catholic School prior to the year of sacramental preparation.
STUDENT INFORMATION
Today's Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Name:

First NameMiddle InitialLast Name
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Grade:
Gender:
Place of Birth:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Baptism:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Church of Baptism:
Address of Church:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
*If child was NOT baptized at Shrine of St. Anne, a copy of the Baptism Certificate MUST be provided.
**If child is NOT baptized Catholic, please contact Karen Oldham at the parish for more information about the OCIA program for Youth
Child Currently Attends:

Other
Is this the child's first year in the program?
If NO, where did child attend last year? Please be specific:
PARENT / GUARDIAN INFORMATION
Father's Name:

First NameLast Name
Religion
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Mother's Name:

First NameMaiden Last Name
Religion
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Registered members at Shrine of St. Anne?
*If NO, Name of Parish where registered:
Should be Empty:

YOUTH RECONCILIATION REGISTRATION

STUDENT INFORMATION

PARENT / GUARDIAN INFORMATION