Religious Ed. Registration Form

                                                                     St Stephen Parish

                                                            Religious Education Registration

                                                             716 Shu-Lar Lane, Clinton, WI 53525

Family Last Name:___________________________                      Date:_____________

Father's Name: _-____________________________                       Home Phone:______________________________

                                                                                                 Mom/Dad Work/Cell:____________________________

Mother'sName:   ____________________________                       Emergency Contact:

Mother's Maiden:____________________________

Custodial Parent, if different from____________________________________ Email:_______________________________________

Home Address:________________________________________

                                                                                                                   Both Parents Catholic?   Y____  N_____

  Child                                       Birthdate         Sex           Grade   Session                  Room   Class

__________________________   _____________    ____         _____     ______                 ______

     Sacrament and Date:     Baptism      Catholic?         Eucharist           Penance              Confirmation

 

  Special Needs: medical, learning disabilities, physical disabilities:

    Child                                     Birthdate         Sex           Grade  Session                  Room   Class

_________________________    ____________    _____        ______    ______                  _______

     Sacrament and Date:     Baptism      Catholic?         Eucharist           Penance              Confirmation

 

  Special Needs: medical, learning disabilities, physical disabilities:

      Child                                  Birthdate         Sex           Grade  Session                  Room   Class

_________________________   ____________     ______    _______      _______                 _________

     Sacrament and Date:     Baptism      Catholic?         Eucharist           Penance              Confirmation

 

  Special Needs: medical, learning disabilities, physical disabilities:

 

      NOTE:  If any of your children were baptized outside of this parish, and you have not already supplied us with a copy

      of each child's baptismal record, you will need to supply a copy for our files.

   Tuition due:                                Tuition Pd:                              Signature: