Religious Education Registration 2021/2022
St. Mary/St. Patrick Catholic Church ~ Durand/Irish Grove
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Please fill in the requested information.
Family Last Name *
Husband's Name
Husband's Phone Number
Wife's Name
Wife's Phone Number
Mailing Address
Family Status *
Email Address
Send Email instead of Mail when possible
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Student 1 Name *
Gender *
Birthdate *
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Grade *
Student 2 Name
Gender
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Birthdate
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Grade
Student 3 Name
Gender
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Birthdate
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Grade
Student 4 Name
Gender
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Birthdate
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Grade
Student 5 Name
Gender
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Birthdate
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Grade
Student 6 Name
Gender
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Birthdate
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Grade
If photos are taken of your child/children, do we have permission to post them on the bulletin boards, website, etc.? No names will be listed unless prior permission is obtained. *
Does your child/children have any special needs we should be aware of? (I.E. visual, hearing, learning disability, behavior disorder, physical limitations, allergies, etc. or medications taken on a regular basis) All information  is kept confidential.  Please list the student's name, grade, and need. *
If parents/guardians listed above are unable to pick their child/children up, please list an alternate person with permission to do so including their Name, Phone Number & Relationship. *
Emergency Contact Information: In the event of an emergency and you cannot be reached, who should we contact? Please list their Name, Phone Number & Relationship. *
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