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2020-2021 First Reconciliation and First Communion
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Last Name
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First Name:
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Middle Name:
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Preferred Name:
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Preferred email for First Reconciliation correspondence:
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Your answer
Additional email for First Reconciliation correspondence:
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Address:
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Date of birth:
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MM
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DD
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City and state of birth:
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Church of baptism: (If your student was not baptized at St. Francis Xavier, please obtain a copy of the baptism certificate dated within the last 6 months. You can request a copy from the church where your child was baptized.)
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Approximate date or year of baptism:
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MM
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DD
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YYYY
School:
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Grade:
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Does your child have any allergies, medical issues, or special concerns? Please explain.
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Are you registered parishioners at St. Francis Xavier?
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Yes
No
If you are not registered at St. Francis Xavier, what parish do you attend?
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Mother's full name:
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Mother's phone number:
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Father's full name:
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Father's phone number:
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Marital status of parents:
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Married
Divorced
Separated
Widowed
Other
Are there any custody issues we need to know? Please explain.
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Emergency contact other than parent:
*
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Emergency contact's number:
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Your answer
Emergency contact's relationship to child:
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Your answer
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