REL. ED. PROG. REGISTRATION FORM

PARENTS' INFORMATION

PARENTS' INFORMATION

FATHER'S LAST, FIRST, AND MIDDLE NAMES

MOTHER'S LAST, FIRST, AND MIDDLE NAMES

BIOLOGICAL MOTHER'S FULL NAME IF THE ABOVE IS A STEP OR A CUSTODIAN

CONTACT EMAIL ADDRESS # 1

CONTACT EMAIL ADDRESS # 2 IF APPLICABLE

MAILING ADDRESS OR ADDRESSES

CONTACT PHONE #1

CONTACT PHONE # 2 IF APPLICABLE

EMERGENCY CONTACT INFORMATION

CHILD # 1 INFORMATION

CHILD # 1 INFORMATION

LAST, FIRST, AND MIDDLE NAMES

DATE OF BIRTH

GRADE AS OF THIS SEPTEMBER

INDICATE THE CALENDAR YEAR OF TODAY

CHURCH ENROLLED

PLACE, CHURCH, AND DATE OF BAPTISM

PLACE, CHURCH, AND DATE OF 1ST COMMUNION IF APPLICABLE

KNOWN MEDICAL CONDITIONS

CHILD # 2 INFORMATION

CHILD # 2 INFORMATION

LAST, FIRST, AND MIDDLE NAMES

DATE OF BIRTH

GRADE AS OF THIS SEPTEMBER

INDICATE CALENDAR YEAR AS OF TODAY

PLACE, CHURCH, AND DATE OF BAPTISM

PLACE, CHURCH, AND DATE 1ST COMMUNION IF APPLICABLE

NOWN MEDICAL CONDITIONS

CHILD # 3 INFORMATION

CHILD # 3 INFORMATION

LAST, FIRST, AND MIDDLE NAMES

DATE OF BIRTH

GRADE AS OF THIS SEPTEMBER

INDICATE CALENDAR YEAR AS OF TODAY

SELECT CHURCH ENROLLED

PLACE, CHURCH, AND DATE OF BAPTISM

PLACE, CHURCH, AND DATE OF 1ST COMMUNION IF APPLICABLE

KNOWN MEDICAL CONDITIONS

CHILD # 4 INFORMATION

CHILD # 4 INFORMATION

LAST, FIRST, AND MIDDLE NAMES

DATE OF BIRTH

GRADE AS OF THIS SEPTEMBER

INDICATE CALENDAR YEAR AS OF TODAY

SELECT CHURCH ENROLLED

PLACE, CHURCH, AND DATE OF BAPTISM

PLACE, CHURCH, AND DATE OF 1ST COMMUNION IF APPLICABLE

KNOWN MEDICAL CONDITIONS

ANY OTHER INFORMATION YOU MAY HAVE FOR THE REGISTRATION

REL. ED. PROG. REGISTRATION FORM

Contact Us

St. Joseph Church

507 Main St, Black River Falls, WI 54615

St. Kevin Church

From The Diocese and

Around The World

REL. ED. PROG. REGISTRATION FORM

Contact Us

St. Joseph Church

507 Main St, Black River Falls, WI 54615

St. Kevin Church

From The Diocese and

﻿Around The World

Around The World