|
Boy ___ or Girl
___
|
Age
____
|
Date of
Application: ___ / ___ /
_____
|
Child's Last Name
|
First Name
|
Date of Birth
|
Place of Birth
|
Street Address (Apt.#)
|
City
|
Zip Code
|
Phone #
|
Father's (First & Last Name)
|
Father's Work Phone #
|
Language spoken at home
|
Mother's (First & Last Name)
|
Mother's Work Phone #
|
|
|
Child's School 2008-2009
|
Grade in Sept. 2008
|
|
|
Baptismal
Information:
|
Church
|
__________________________________________
|
|
|
|
City/State
|
__________________________________________
|
|
|
|
|
Date
|
__________________________________________
|
|
Please check:
|
1. ____ Baptismal
certificate is on file at Epiphany School
of Religion.
|
|
|
|
2. ____ Baptismal
certificate is attached.
|
|
|
Yes -
Where
|
Yes -
When
|
No
|
|
Have
you received the Sacrament of
Reconciliaton
(Confesson)?
|
|
|
|
|
Have
you received the Sacrament of
Hold
Communion?
|
|
|
|
|
|
Previous religious
education:
|
|
|
|
|
|
|
|
___
School of Religion - grades
________
|
where
____________________________
|
|
___
Catholic school - grades
________
|
where
____________________________
|
|
___
Other __________________________
|
where
____________________________
|
|
What church does the
family attend?
_________________________________________
|
|
Are you registered
in Epiphany Parish? ______ (yes or
no)
|
|
Do you wish to
register in Epiphany Parish? ______ (yes
or no)
|
|
Is the registration
fee attached? Yes ___ or No
___
|
|
|
|
|
|
If
a parent or guardian
cannot be reached, whom
should we contact in
case of an
emergency?
|
Name
|
Phone
#
|
Relationship
|
|
|