Children Program Religious Education

Student's First Name

Middle Name

Last Name

Contact EMail

Contact Phone

Student's Birth Date

Student's Address

Parish and Date of Student's Baptism

Does the Student Live with Her or His Mother, Father or Both Parents?

Mother's Full Name and Address (if Different from Above)

Mother's Mobile Phone Number

Father's Full Name and Address (if Different from Above)

Father's Mobile Phone Number

Are You Parishioners of the Cathedral of SS. Peter and Paul? If Not, then Where?

Does the Student Have Any Allergies, Such as Food, Environmental, Medicine, or Other Allergies? If So, Please Explain

Person to Contact in Case of Emergency (Name/Address/Phone/EMail)