Family Last Name:________________________________________Parishioner ID #__________
Student Name: (As it appears on the Baptismal Cert.) ______________________________________________
Grade in Sept. ___________ Sex:      Female      _  Male ___ Religion________________________
Public School Attending ________________________________
Language___________________ Date of Birth:______________
Health Problems or Other Conditions:________________________________________________

Sacramental Information
(Original certificates must be shown at time of registration)
Baptism Date:________  Church _________________________________________________
Address ________________________________________________
First Eucharist Date: _______  Church _________________________________________________
Address ________________________________________________
Confirmation Date: _______ Church _________________________________________________
Address ________________________________________________
Reconciliation Date: _______ Church _________________________________________________
Address ________________________________________________

Prior Religious  Education
Church Name:_______________________________________Dates Attended: _______to_______ Grade_________
Address:____________________________________________

Church Name:_______________________________________Dates Attended: _______to_______ Grade_________
Address:____________________________________________
 

Permission to take the Bus to the PSR Program from School
(For 3rd and 4th Graders taking the bus from their school to the PSR program on Wednesday afternoons)

Permission Granted____________________________________________  Date:_________________
                                            (Signature of Parent or Guardian)
 
 
For Office Use Only:   After seeing original sacramental certificate, please initial: 
Baptism ______Reconciliation______  Communion______ Confirmation______