Religious Education Registration

The student(s) your are registering live with

Select One
First Name Please enter valid data.
Middle Name Please enter valid data.
Last Name Please enter valid data.
Select One
First Name Please enter valid data.
Middle Name Please enter valid data.
Maiden Name Please enter valid data.
Last Name Please enter valid data.

Street 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.

Email REQUIRED Please fill out this field. Please enter an email address.

Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Father's Work Phone Number Please enter a phone number.

Father's Cell Phone Number Please enter a phone number.

Mother's Work Phone Number Please enter a phone number.

Mother's Cell Phone Number Please enter a phone number.

Father's Religion REQUIRED Please fill out this field. Please enter valid data.

Mother's Religion REQUIRED Please fill out this field. Please enter valid data.

If students are not living with both mother and father, please complete this section.

Father - check all that apply Deceased Separated Divorced Remarried
Please list date of each event
Mother - check all that apply Deceased Separated Divorced Remarried
Please list date of each event

Number of Children Being Registered REQUIRED Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birth Date REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Female Male Please fill out this field.
- Grade for the 2021-2022 School Year REQUIRED Please fill out this field.
- Name of School REQUIRED Please fill out this field. Please enter valid data.
- Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.? REQUIRED No Yes Please fill out this field.
- If yes, explain below (please list any special services your child is receiving from their school or through private counseling). Please do not use just initials in describing any difficulties. List any medications they may be taking for these difficulties.
- Please be assured this information will be kept confidential.
- Class Time REQUIRED Please fill out this field.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birth Date REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Female Male Please fill out this field.
- Grade for the 2021-2022 School Year REQUIRED Please fill out this field.
- Name of School REQUIRED Please fill out this field. Please enter valid data.
- Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.? REQUIRED No Yes Please fill out this field.
- If yes, explain below (please list any special services your child is receiving from their school or through private counseling). Please do not use just initials in describing any difficulties. List any medications they may be taking for these difficulties.
- Please be assured this information will be kept confidential.
- Class Time REQUIRED Please fill out this field.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birth Date REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Female Male Please fill out this field.
- Grade for the 2021-2022 School Year REQUIRED Please fill out this field.
- Name of School REQUIRED Please fill out this field. Please enter valid data.
- Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.? REQUIRED No Yes Please fill out this field.
- If yes, explain below (please list any special services your child is receiving from their school or through private counseling). Please do not use just initials in describing any difficulties. List any medications they may be taking for these difficulties.
- Please be assured this information will be kept confidential.
- Class Time REQUIRED Please fill out this field.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birth Date REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Female Male Please fill out this field.
- Grade for the 2021-2022 School Year REQUIRED Please fill out this field.
- Name of School REQUIRED Please fill out this field. Please enter valid data.
- Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.? REQUIRED No Yes Please fill out this field.
- If yes, explain below (please list any special services your child is receiving from their school or through private counseling). Please do not use just initials in describing any difficulties. List any medications they may be taking for these difficulties.
- Please be assured this information will be kept confidential.
- Class Time REQUIRED Please fill out this field.
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birth Date REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Female Male Please fill out this field.
- Grade for the 2021-2022 School Year REQUIRED Please fill out this field.
- Name of School REQUIRED Please fill out this field. Please enter valid data.
- Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.? REQUIRED No Yes Please fill out this field.
- If yes, explain below (please list any special services your child is receiving from their school or through private counseling). Please do not use just initials in describing any difficulties. List any medications they may be taking for these difficulties.
- Please be assured this information will be kept confidential.
- Class Time REQUIRED Please fill out this field.
Child 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birth Date REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Female Male Please fill out this field.
- Grade for the 2021-2022 School Year REQUIRED Please fill out this field.
- Name of School REQUIRED Please fill out this field. Please enter valid data.
- Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.? REQUIRED No Yes Please fill out this field.
- If yes, explain below (please list any special services your child is receiving from their school or through private counseling). Please do not use just initials in describing any difficulties. List any medications they may be taking for these difficulties.
- Please be assured this information will be kept confidential.
- Class Time REQUIRED Please fill out this field.
Child 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birth Date REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Female Male Please fill out this field.
- Grade for the 2021-2022 School Year REQUIRED Please fill out this field.
- Name of School REQUIRED Please fill out this field. Please enter valid data.
- Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.? REQUIRED No Yes Please fill out this field.
- If yes, explain below (please list any special services your child is receiving from their school or through private counseling). Please do not use just initials in describing any difficulties. List any medications they may be taking for these difficulties.
- Please be assured this information will be kept confidential.
- Class Time REQUIRED Please fill out this field.
Child 8
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birth Date REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Female Male Please fill out this field.
- Grade for the 2021-2022 School Year REQUIRED Please fill out this field.
- Name of School REQUIRED Please fill out this field. Please enter valid data.
- Is this child experiencing physical or emotional difficulties, a learning disability, hyperactivity, etc.? REQUIRED No Yes Please fill out this field.
- If yes, explain below (please list any special services your child is receiving from their school or through private counseling). Please do not use just initials in describing any difficulties. List any medications they may be taking for these difficulties.
- Please be assured this information will be kept confidential.
- Class Time REQUIRED Please fill out this field.