Religious Education Registration

First Name Please enter valid data.

Last Name Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Primary Email REQUIRED Please fill out this field. Please enter an email address.

Mother Cell Please enter a phone number.

First Name Please enter valid data.

Last Name Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Father Cell Please enter a phone number.

Primary Email Please enter an email address.

This form is to register your first child in a religious education program. Select and add additional children at your left.

Program Registration PreK to 6th Grade Middle School (Grade 7-8) High School Youth Group (Grade 9-12)

First Name Please enter valid data.

Last Name Please enter valid data.

Birthdate Please enter a date.

Gender Male Female

Grade

School grade 2022-2023

Please enter valid data.

List any/all Allergies REQUIRED

If the child has no known allergies, please type none

Please fill out this field. Please enter valid data.

Medical Conditions (list none, if none) REQUIRED Please fill out this field. Please enter valid data.

Sacrements Recieved REQUIRED Baptism First Eucharist Confirmation Penance None Please fill out this field.

St. Joseph