Youth Formation

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Sacred Heart Catholic Church
Rel. Ed. Registration Form
Grades 1-11
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  First child $25; Additional children $15 each (Please fill out form for each child and pay separately.) REQUIRED $ Please fill out this field. Please enter a positive decimal.
  
  Student's First, Middle, Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mailing 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.
  
  Student's Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Student's age REQUIRED Please fill out this field. Please enter valid data.
  
  Born in what City, State Please enter valid data.
  
  Grade Fall of 2022: REQUIRED Please fill out this field. Please enter valid data.
  
  Has your child been baptized? Yes or No Please enter valid data.
  
  Has your child made their First Communion? Yes or No Please enter valid data.
  
  Adult in Charge Name (First, Middle, MAIDEN, Last) REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Student & Cell # REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Adult in Charge Name (First, Middle, MAIDEN, Last) REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Student & Cell # REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Any special learning needs or physical challenges (Autism, Dyslexia, Hearing Impairment, etc.) REQUIRED Please fill out this field.
  
  Drug or Other Allergies: REQUIRED Please fill out this field. Please enter valid data.
  
  NAME OF ANYONE "NOT ALLOWED" TO PICK UP YOUR CHILD
  
  PLEASE NOTE: IF YOUR CHILD ATTENDED OUR REL. ED PROGRAM LAST YEAR YOU CAN STOP HERE. WE SHOULD HAVE THE REST OF THE INFO WE NEED. IF NOT, WE WILL CALL YOU. IF ANY OF THE BELOW HAS CHANGED THEN PLEASE UPDATE THE INFO. IF NEW STUDENT THEN PLEASE PROCEED. Please enter valid data.
  
  Parents Marital Status Please enter valid data.
  
  If remarried to whom? Mother list spouse below. Please enter valid data.
  
  If remarried to whom? Father list spouse below. Please enter valid data.
  
  Student's Place of Baptism (Church and City, State) Please enter valid data.
  
  Student's Date of Baptism Please enter a date.
  
  Total:
  
  Submit
  
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