Current Address(Including City, State and Zip Code): *
Your answer
Home Phone Number: *
Your answer
Cell Phone Number: *
Your answer
Email Address (Mother): *
Your answer
Email Address (Father): *
Your answer
Ethnicity: Is the student Hispanic or Latino? *
Race: What is the student's race? *
Choose
White (Not Hispanic)
Asian
American Indian or Alaska Native
Black or African American (Not Hispanic)
Other (Specify)
Student's Religion: *
Your answer
Family Affiliation: *
Registered and Contributing in What Parish? *
Choose
St. Ignatius
St. Mary's
OLMM
Sacred Heart
Other
Not Registered or Contributing in a Parish
Geographically in What Parish? *
Choose
St. Ignatius
St. Mary's
OLMM
Sacred Heart
Other
Will you be able to provide a copy of your child's birth certificate? *
Will you be able to provide a copy of your child's baptismal certificate? *
Baptismal Information - Must include Date of Sacrament, Church Name, and Location (Enter Not Applicable if Non-Catholic) *
Your answer
Reconciliation Information - Must include Date of Sacrament, Church Name, and Location (Enter Not Applicable if Non-Catholic OR if Child Has Not Received Yet) *
Your answer
First Holy Communion Information - Must include Date of Sacrament, Church Name, and Location (Enter Not Applicable if Non-Catholic OR if Child Has Not Received Yet) *
Your answer
Confirmation Information - Must include Date of Sacrament, Church Name, and Location (Enter Not Applicable if Non-Catholic OR if Child Has Not Received Yet) *
Your answer
Will you be able to provide a copy of your child's health records? Specifically, the immunization record, which is mandatory as required by the Diocese of Rockville Centre. *
Do you acknowledge the required registration fee of $150? (Check made payable to LBCRS or Cash) *
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