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Registration 2011-2012
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Registration Form

Registration Form

___________________________________________________________________
Please provide information about your family in this section
Please Check One
Family Name (Required)
Child(ren)'s Last Name (If Different)
Home Phone
Alternate Phone (Cell)
Work Phone (Father)
Work Phone (Mother)
Include E-mail address where we can inform you of class cancellations (required)
If you would like E-mail to be sent to a second address, please provide:
Father's First Name
Mother's First and Maiden Name
Name of Guardian, if different from above
How would you like your mail addressed
Street Address
City
State
Zip
Emergency Contact (Name)
Emergency Contact: Relationship
Emergency Contact Phone

___________________________________________________________________
Family Life Permission

The Religious Education program includes a “Family Life” component as prescribed by the Archdiocese of Baltimore. I understand that an orientation will be provided for parents before “Family Life” begins. I also understand that I am afforded the opportunity to review any and all preparation materials by contacting the R.E. office.

___________________________________________________________________
Please provide information on how you can help in this section
Volunteer Name (First and Last)
I am interested in helping as
for Grade(s)
Session Choice
Other Volunteer Area of Interest or Talent You Can Share

___________________________________________________________________
Child #1 Information
Child's First and Last Name
Gender (required)
Age
Child's Date of Birth (mm/dd/yyyy)
popup calendar
Grade
Session Choice
Please check all sacraments child has received
Special Needs: medical, learning disabilities, physical disabilities
Public/Private School Name

If you are registering this child for the first time, please complete the following sacramental information.
Baptism Note: If this child was baptized outside of this parish, you will need to supply a copy of his/her baptism certificate for our files.
Name of Church of Baptism
Mailing Address of Church of Baptism
1st Eucharist Date and Church Name
Confirmation Date and Church Name

___________________________________________________________________
Child #2 Information
Child's First and Last Name
Gender
Age
Child's Date of Birth (mm/dd/yyyy)
popup calendar
Grade
Session Choice
Please check all sacraments child has received
Special Needs: medical, learning disabilities, physical disabilities
Public/Private School Name

If you are registering this child for the first time, please complete the following sacramental information.
Baptism Note: If this child was baptized outside of this parish, you will need to supply a copy of his/her baptism certificate for our files.
Name of Church of Baptism
Mailing Address of Church of Baptism
1st Eucharist Date and Church Name
Confirmation Date and Church Name

___________________________________________________________________
Child #3 Information
Child's First and Last Name
Gender
Age
Child's Date of Birth (mm/dd/yyyy)
popup calendar
Grade
Session Choice
Please check all sacraments child has received
Special Needs: medical, learning disabilities, physical disabilities
Public/Private School Name

If you are registering this child for the first time, please complete the following sacramental information.
Baptism Note: If this child was baptized outside of this parish, you will need to supply a copy of his/her baptism certificate for our files.
Name of Church of Baptism
Mailing Address of Church of Baptism
1st Eucharist Date and Church Name
Confirmation Date and Church Name

___________________________________________________________________
Figure out your Tuition based on the following questions:

Do you support the parish through verifiable means of support (that is, either Envelopes or Electronic Funds Transfer)?
If yes, choose verifiable in the drop down box below
If no, choose non-verifiable in the drop down box below.

How many children are enrolled?
One,
Two, or
Three or More?

Is it on or before August 1, 2011?
If so, your family will receive a $12 early registration discount.

Are you a Catechist?
If so, please contact the Religious Education office at 410-647-4892 for your tuition rate.

Find Your Tuition

Please make note your Tuition before hitting the submit button below.
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