Author: CCD

St. Joseph & St. Peter Catholic Parishes
Registration for Religious Education 2022-2023
PLEASE FILL OUT ENTIRE SHEET!!

Communication is important! We prefer to utilize e-mail where possible. E-mail addresses will only be given out to the teachers and group leaders. How do you wish to receive information from us regarding calendar changes, events, etc)?
_______ Via Postal Mail
_______ Via E-Mail (this is the best way for us to contact you expediently and lower our mailing costs.

FAMILY NAME	FATHER’S NAME	MOTHER’S NAME
	FATHER’S FAITH	MOTHER’S FAITH
MAILING ADDRESS	CITY & STATE	ZIP
HOME PHONE #	FATHER’S WORK#	MOTHER’S WORK#
E-MAIL / – FATHER / --MOTHER	FATHER’S CELL #	MOTHER’S CELL #
Custodial care information:	Both _______ Father _______	Mother ______ Other ______

Emergency Contact Name: ________________________________________ Phone: _________________________
Specific Medical Information:
Allergies (medication, foods, plants, insects, etc.) ________________________________________________
Current Medications: _________________________________________________________________________
Other Special Medical Conditions: ______________________________________________________________
Parent/Guardian Signature: _______________________________________________ Date: ______________________

Child’s Full Name	M or F	Birthdate	Please mark the sacraments the child has received: (x)	Grade	School / attending
PLEASE INCLUDE LAST NAME IF IT IS DIFFERENT FROM PARENTS
1
2
3
4
5

What parish are you a member of? ______________________________________________________

Bap Recon 1st Comm Confirm

Tuition Fees: $20.00 per child up to 3 children. Tuition is not to exceed $60 per family. Balance due at registration.
If you need to set up a schedule of payments, please talk to Jean Limoges in the Parish Office. We will not turn anyone away if they cannot pay!
DATE RECEIVED IN OFFICE CHECK NUMBER -OR- CASH AMOUNT AMOUNT RECEIVED
. ____________________. . _____________ . . _________ . . __________ .