Religious Education Registration

: Religious Education Registration Form

: CHILD INFORMATION

First Name
Last Name
Date of Birth
My child has the following sacraments: BaptismFirst Holy Communion

: PARENT'S OR GUARDIAN INFORMATION

Parent's or Guardian's Full Name
Parent's or Guardian's Phone Number
Parent's or Guardian's Email Address
Parent's or Guardian's Mailing Address

: MEDICAL INFORMATION AND EMERGENCY CONTACT

: For medical information please specify if the child has ADD, allergies, or physical conditions we should be aware of.
Medical Information
In case of an emergency contact (Doctor & Hospital)

Please provide the full names of all authorized adults to pick up your child
I hereby authorize any hospital or doctor to render inmediate required aid for emergency health and safety of my child. I understand that the expense of this service will be accepted by me.: I acceptI decline

The information in this form was provided by:
: Signature (to be signed in the office)
: X

Today's date

St. Margaret Mary Alacoque Roman Catholic Church