Saint Joseph Parish School for Religious Education

School Year - 2004-2005

New and RE-REGISTRATION

(Confidential - for Church use only)

Name on Mailbox_________________________________________________

Student’s Name__________________________________________________

(Last) (First) (Middle)

Address_________________________________________________________

Home Phone____________________Business Phone___________________

Date of Birth_________________ City of Birth__________________

State________________________Country_____________________________

Baptismal Date_______________ Church_____________________________

City________________________ State/Country_______________________

First Eucharist?communion Date______ Church______________________

City______________________________ State/Country

First Reconciliation Date_______ City/Country________________________

Father’s Name___________________________________________________

(Last) (First) (Middle)

(Did you receive?) (Did you receive?)

Father’s Religion________First Eucharist(Yes)(No) Confirmation (Yes)(No)

Mother’s Maiden Name_________________________________________

(Last Name) (First) (Middle)

(Did you receive?) (Did you receive?)

Mother’s Religion________First Eucharist(Yes)(No) Confirmation (Yes)(No)

Mother’s Name Now:_____________________________________________

(Last) (First) (Middle)

Church where parents were married_________________________________

Mother’s Occupation______________________________________________

Telephone_______________________________________________________

Father’s Occupation______________________________________________

Telephone_______________________________________________________

CONTINUED ON BACK - PLEASE TURN PAPER OVER

Public School (student) Now Attending____________________Grade______

Has student previously attended Religious Education Classes?__________

If yes, grade completed___________

Does student have learning disability? (please explain)_________________

Does student have medical disability? (please explain)_________________

________________________________________________________________

Does student read and speak English?_______________________________

Other Children___Last________________First__________________Age___

___Last________________First__________________Age___

___Last________________First__________________Age___

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Guardian’s Name/Phone (Other than Parent)__________________________

Which Mass do you attend? Sat. Sun. Sun. Sun. Spanish Sun.

(Please Circle One) 5:30 7:30 9:00 l0:30 12 Noon

Would you like to be:

a Lector or Eucharistic Minister?___________

a member of the choir?___________

a Catechist?___________

a member of the Pastoral Council?_________

Other?_________________________________

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Do not write below this line - this space for office use only

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Date of Registration___________ Tuition Paid $___________________

Baptismal Certificate Required____________

Has not received: Baptism______Eucharist______Confirmation______

Grade assigned_________ Catechist_____________________________

Name and Grade of Brother/Sister in School________________________