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Religious Education Registration Form

General Information

Child's First Name:*

Child's Last Name:*

Date of Birth: (ex. 00/00/0000)*

Sex:

Grade Entering:*

School:*

Ethnic Background:*

Has the child been baptized?*

Has the child received reconciliation?*

Has the child received Holy Communion?*

Has the child received Confirmation?*

*Family Information

Father's Name:*

Mother's Name:*

Mother's Maiden Name:*

Legal Guardian's Name:*

Address:*

Address (Unit # or Floor):

City:*

State:*

Zip Code:*

Home Telephone Number:*

Cellphone Number:*

Work Telephone Number:*

Primary Family Email:

Are you a registered member of Holy Name Cathedral Parish?*

List if child has allergies, intolerances, relevant medical issues, and other important notes:

*Please prepare to submit a copy of your Baptismal Certificate at the first session.

*Please be assured that all information you give us will be kept confidential

*I attest to the truth of the information above.

Date: (ex. 00/00/0000)*