Registration Form 
Welcome to Immaculate Conception Parish Faith Formation for children in grade kindergarten through grade 10.  Use this form to register your child/children. Please submit one form per child.  If you have any questions contact Teresa Frederick, Faith Formation Director, at 814-226-8433 ext. 103.
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Email *
Primary Address *
Father's Name *
Father's Phone Number *
Father's Email *
Mother's Name *
Mother's Phone Number *
Mother's Email *
Child's Name *
Child's Date of Birth *
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/
DD
/
YYYY
School District and Grade *
Allergies *
Special Learning Needs *
Child lives with *
If necessary, provide the second address.
Emergency Contact Name *
Emergency Contact Phone *
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