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Registration 2022-23
Religious Ed.: Pre k through 6th, Jr. Samaritan 7th through 8th, Life Teen 9th grade through 12th.
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E-Mail
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Family Name
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Parent E-mail
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Student Last Name
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Student First Name
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Sex
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Date of Birth
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Current School
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Grade Level
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Student Email
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Was child enrolled in religious education in:
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2022
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Name of parish last enrolled
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Sacraments completed
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Baptism
Communion
Reconciliation
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Mother's Name
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Mother's Occupation
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Mother's Cell Phone Number
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Father's Name
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Father's Occupation
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Father's Cell Phone Number
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Address
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City
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State
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Zip Code
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Emergency Contact name
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Emergency Contact Phone Number
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Allergies, medical conditions, or restrictions
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Program Requesting
Pre-K through 6th. Sunday mornings 9:30 to 10:30 am
Jr. Samarita 7th-8th grade Sunday morning 9:15 to10:45 am
Life-Teen 9th through 12th Sunday Evening 7 to 8:30 pm
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