Sacred Heart Religious Education Registration

 

Student’s Name: __________________________________

                              (first)                                     (middle)                         (last)

 

Address:________________________________________

                   (street)                                                                  (city)            (zip code)

 

Phone:  ____________________

 

Date of Birth:_ __________________________

 

Date of Baptism: ________________________

 

Place of Baptism: ______________________________________

                              (Church)                                        (City)                                    (State)

 

Father’s Name: ________________________________________ 

                              (first)                                                   (maiden)                  (last)

 

Mother’s Name: ______________________________________

                               (first)                                                   (maiden)                  (last)

 

Sacraments received:  ___ Reconciliation   ___ Eucharist

 

Emergency phone number:  _____________________________

Email address:  ________________________________________

Special needs,Allergies?  ________________________________

_____________________________________________________

 

(Please indicate which grade as well as which session.)

Grade: ___  PreK -5 Sun.    ____ 1-5 Mon.   ___ 6, 7-8 Mon. eve. 

             ____ 9-10 (Conf.)

 

Tuition: _____________

 

2009-2010  1 child:  60.00   2 children:  85.00  3 or more:  100.00