Communion Catch-Up

Primary Parent/Guardian Info

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Receive emails? REQUIRED Yes No Please fill out this field.
Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Marital Status REQUIRED Please fill out this field.
Are there any custody issues we should be made aware of? If there is a custody agreement please send a copy to the Religious Education Department. REQUIRED No Yes. I will send a copy to the Religious Ed Office Please fill out this field.
Religion REQUIRED Please fill out this field. Please enter valid data.
Maiden Name REQUIRED
Mothers are required to include their maiden names. Fathers, please respond "n/a"
Please fill out this field. Please enter valid data.
Are you in parish? REQUIRED Yes No Please fill out this field.

Secondary Parent/Guardian Info

First Name Please enter valid data.

Last Name Please enter valid data.
Email Please enter an email address.
Phone Number Maximum 20 characters Please enter a phone number.
Receive emails? Yes No
Address Please enter valid data.
City Please enter valid data.

State

Zip Please enter a zip code.
Marital Status
Religion Please enter valid data.
Maiden Name
Mothers are required to include their maiden names. Fathers, please respond "n/a"
Please enter valid data.
Are you in parish? Yes No

Choose an emergency contact

Please choose someone who is not the student's parent/guardian

Emergency Contact Info

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Relationship to student(s) REQUIRED Please fill out this field. Please enter valid data.

Tell us all about the students you're enrolling:

Volunteer Information:

Are you interested in volunteering? REQUIRED Yes No Please fill out this field.

First Name Please enter valid data.

Last Name Please enter valid data.

Phone Number Please enter a phone number.

How are you interested in volunteering? Teacher Teacher Assistant Hall Monitor Substitute Parking Lot Helper (Sundays only)

terms and conditions

Medical Emergency Release REQUIRED Yes No Please fill out this field.

I understand that in the case of injury or illness, every effort will be made to contact me in a medical emergency. In the event I cannot be reached, I give permission to parish staff to secure all proper and necessary treatment for my child(ren). I understand that no liability is assumed by the church or the Archdiocese for claims that may arise.

Parental Consent REQUIRED Yes No Please fill out this field.

In case of an emergency, I give permission for my child to receive emergency medical treatment and, if necessary, be transported to the nearest appropriate medical facility

Photo Consent REQUIRED Yes No Please fill out this field.

I understand that photos of my child(ren) may be taken and used in Parish publications including web and print media. By answering yes, I consent to this.

Communion Catch-Up