Family Information

Parent/Guardian 1: Full Name

Parent/Guardian 2: Full Name

Primary Phone Number

I can receive texts at this number.

Primary Email

Secondary Email (optional)

Address

Home Parish

Emergency Contact (non-parent)

Emergency Contact Phone Number

Does your family or child(ren) have any allergies, special learning needs, or any other needs we should be aware of?

Student Information

Student First and Last Name

Date of Birth

Gender

We are registered parishioners at:

Grade for 2022-2023 School Year

School

Registration costs us $4-5 per student in service fees. Are you willing to cover that fee for this child?

Running Total

$0.00

Coupon Code

Total

$0.00

A photo consent waiver will be shown on the confirmation page.

Name

Credit Card

Address

Mobile Phone Number