Your Name (required)
Your Email (required)
Your Child's Name (required)
Your Child's Cell Phone Number
Your Child's Grade ---9th10th11th12th
Your Address
Emergency Contact (required)
Emergency Contact Phone Number (required)
Allergies
Medications
Physcial Handicaps, Limitations, or Conditions
Health Insurance Provider
Policy Number
Policy Member Name
I ---amam not the Parent/Legal Guardian of the above mentioned child. I will return a signed permission slip and $60 fee to Isaac Deken by March 11, 2012 (required).
Additional Information
To register as a parishioner, please fill out the information below:
Your Name
Occupation
Date of Birth
Sacraments Received Baptism First Eucharist Confirmation Marriage
Your Phone Number (required)
Street Address (required)
City and Zip Code (required)
Your Spouse's Name (if applicable)
Spouse's Occupation
Spouse's Date of Birth
Spouse's Sacraments Received Baptism First Eucharist Confirmation Marriage
Family Members and Birthdays (if applicable)
Donation Information ---Please send envelopesI would like to donate through "Online Giving"
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