St. Rose of Lima Faith Formation – Religious Education Registration Form – Online

Family Name *

Are you registered at St. Rose of Lima Parish?

Yes
No

Father's Name

Father's Religion

Mother's Name

Mother's Religion

Address of Parent(s)/Guardian(s)

Home Phone

Cell

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email

Emergency Contact

Emergency Contact Relationship

Emergency Contact Phone

2021-22 Fees: 1 Child $30.00 Each Additional is $15 Make Checks Payable to St. Rose Church

Bill In September
Payment Enclosed

First Child

Child's Full Name

First

Last

Date of Birth

Place of Birth

School

Grade (Fall 2021)

Sacraments Received - Yes or No & If Possible Indicate Year Received

Baptism

Reconciliation

Eucharist

Confirmation

Special Needs/Other Information About Your Child

Second Child

Child's Full Name

First

Last

Date of Birth

Place of Birth

School

Grade (Fall 2021)

Sacraments Received - Yes or No & If Possible Indicate Year Received

Baptism

Reconciliation

Eucharist

Confirmation

Special Needs/Other Information About Your Child

Third Child

Child's Full Name

First

Last

Date of Birth

Place of Birth

School

Grade (Fall 2021)

Sacraments Received - Yes or No & If Possible Indicate Year Received

Baptism

Reconciliation

Eucharist

Confirmation

Special Needs/Other Information About Your Child

Fourth Child

Child's Full Name

First

Last

Date of Birth

Place of Birth

School

Grade (Fall 2021)

Sacraments Received - Yes or No & If Possible Indicate Year Received

Baptism

Reconciliation

Eucharist

Confirmation

Special Needs/Other Information About Your Child

Volunteers Needed!

Check Those Areas In Which You Would Be Willing To Volunteer

St. Rose of Lima Faith Formation – Religious Education Registration Form – Online

First Child

Sacraments Received - Yes or No & If Possible Indicate Year Received

Second Child

Sacraments Received - Yes or No & If Possible Indicate Year Received

Third Child

Sacraments Received - Yes or No & If Possible Indicate Year Received

Fourth Child

Sacraments Received - Yes or No & If Possible Indicate Year Received

Volunteers Needed!

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