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Religious Education

* Required Fields

First Name*:
Middle Name*:
Last Name*:
Zip Code*:
Cell Phone*:
Father's Name*:
Father's Religion*:
Mother's Name*:
Mother's Religion*:

Student Information

Grade of Student*:
Date of Birth*:
Public School
Student Attends*:
Special Health Problems
or Medications:
Member of Which Parish*:

Sacraments Received

Baptism Date*:
Name and City of Church*:
Penance Date*:
Name and City of Church*:
Eucharist Date*:
Name and City of Church*:

Other children in family attending Religious Education or Tiny Seeds*:

Signature indicates agreement with policies in religious education handbook found at*

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