CO-CATHEDRAL OF SAINT THERESA
OF THE CHILD JESUS
Religious Education Registration Form Birth Date
School:
Grade:
School:
Grade:
Gender (MfF)
Baptism Church/Location
Eucharist Church/Location
Confirmation Church/Location
2
3
School:
Grade:
Please indicate which sacraments vou received?
Please indicate which sacraments vou received?
Are oarents married in the Catholic Church? Yes / No
Father: Mother:
Primary Address,
_
Contact Info: Home Number
Apt#__
_ Cell
City
Zip
Father's Name: Last
- - - - - - - - - First- - - - - - - Phone
Religion
_
Mother's Name: Last
First- - - - - - - - Phone
Religion,
_
Guardian's Name: Last
First. _ - - - - - - 足
Phone
Religion
_
Emergency Contact:
_
Phone
Relationship
_
Alternate Persons You Authorize to Pick-Up Child/ren: Name Name
_ _
Phone Phone
Relationship Relationship
_ _
Parents: To enable us to better serve your children, please indicate any special needs/instructions, diet, allergies, disabilities (i.e. autism, ADD/ADHD or physical challenges) as well as any medication(s) your child is taking:
Parent Volunteer Opportunities: (please check all interested areas): 0 Life Teen Chaperones o Catechist Assistant (K-8) o Prayer & Worship Team 0 Snack Preparation (Sunday Mornings) o Other:
---------------------------------
Parent/Guardian Signature:
_
Date:
_ Revised August 2009
712 NORTH SCHOOL STREET, HONOLULU, HI PHONE: 808.521.1700
96817
FAX: 808.599.3629