Gretna St Patrick Religious Ed Registration
Registration for 2022-2023 School Year
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Email *
Primary Phone Number *
Family Last Name *
Mother's Name *
Mother's Phone *
Primary Email *
Mother Willing to Volunteer (If yes, please go to https://stpatricksgretna.org/mesmerize/education/religious-education/re-form/ and complete the Adult Volunteer form.) *
Father's Name *
Father's Phone *
Secondary Email *
Father Willing to Volunteer (If yes, please go to https://stpatricksgretna.org/mesmerize/education/religious-education/re-form/ and complete the Adult Volunteer form.) *
I grant permission for my child(ren)'s picture and/or name to be included in the bulletin, social media, newsletter, website, etc. *
Address update: *
Required
Home Street Address
If address has changed.
City
State
Zip
Subdivision
Additional Home Street Address (if applicable)
City
State
Zip
Subdivision
Registered Member of St Patrick Parish: *
If not, contact the Parish Office, 402-332-4444.
Child #1 First Name *
Child #1 Last Name (if different than parent's)
Child #1 Nickname (if applicable)
Child #1 Birthdate *
MM
/
DD
/
YYYY
Child #1 Gender *
Please list any allergies, medical conditions, or learning/behavioral issues we should be aware of.
Child #1 Class Fall 2022 *
Child #1 Sacraments Received *
Required
Child #1 - First Class Choice *
Child #1 - Second Class Choice *
Child #2 First Name
Child #2 Last Name (if different than parent's)
Child's #2 Nickname (if applicable)
Child #2 Birthdate
MM
/
DD
/
YYYY
Child #2 Gender
Clear selection
Please list any allergies, medical conditions, or learning/behavioral issues we should be aware of.
Child #2 Class Fall 2022
Clear selection
Child #2 Sacraments Received
Child #2 - First Class Choice
Clear selection
Child #2 - Second Class Choice
Clear selection
Child #3 First Name
Child #3 Last Name (if different than parent's)
Child #3 Nickname (if applicable)
Child #3 Birthdate
MM
/
DD
/
YYYY
Child #3 Gender
Clear selection
Please list any allergies, medical conditions, or learning/behavioral issues we should be aware of.
Child #3 Class Fall 2022
Clear selection
Child #3 Sacraments Received
Child #3 - First Class Choice
Clear selection
Child #3 - Second Class Choice
Clear selection
Child #4 First Name
Child #4 Last Name (if different than parent's)
Child #4 Nickname (if applicable)
Child #4 Birthdate
MM
/
DD
/
YYYY
Child #4 Gender
Clear selection
Please list any allergies, medical conditions, or learning/behavioral issues we should be aware of.
Child #4 Class Fall 2022
Clear selection
Child #4 Sacraments Received
Child #4 - First Class Choice
Clear selection
Child #4 - Second Class Choice
Clear selection
Child #5 First Name
Child #5 Last Name (if different than parent's)
Child #5 Nickname (if applicable)
Child #5 Birthdate
MM
/
DD
/
YYYY
Child #5 Gender
Clear selection
Please list any allergies, medical conditions, or learning/behavioral issues we should be aware of.
Child #5 Class Fall 2022
Clear selection
Child #5 Sacraments Received
Child #5 - First Class Choice
Clear selection
Child #5 - Second Class Choice
Clear selection
Select how you will send payment: *
One student: $85,   Two students: $170,   Three+ students: $230
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