Registration

Either copy and paste this form to the email address on the bottom of this page or bring it to the rectory office.

St. Robert Bellarmine Catholic Parish

Religious Education Registration Form

(One form per family)

Family’s Last Name: ________________________________________

Father: ________________________________                                              MOTHER: _________________________________________

Mailing Address: ________________________________________________________ PHONE: _________________________________

Physical Address: _______________________________________________________ CELL phone: _______ ___________

EMAIL ADDRESS: ___________________________________________

emergency contact: ______________________________RELATIONSHIP: _______________ PHONE:______    ____________________

Student’s Name	birth date	Grade	Baptism when & where	First Communion when & where
			Yes/No	Yes/No
			Yes/No	Yes/No
			Yes/No	Yes/No
			Yes/No	Yes/No

Are any of the above listed children in Special Education programs in school or have any special needs? YES □ No □ Please explain.

____________________________________________________________________________________________________________________

Does any child have any dietary restrictions? Yes □ No □ Please explain.

____________________________________________________________________________________________________________________

Is there any other information needed to insure the well being of your children while in our program? Yes □ No □ Please explain.

____________________________________________________________________________________________________________________

Child/Children reside with: □ Both parents □ One parent- Father/Mother □ Grandparent (s) □ Other: _____________________

Is your family registered at St. Robert’s: □ Yes □ No (If no, please make sure to get or ask for a parish registration form)

COMMENTS OR CONCERNS: ____________________________________________________________________________________________________________________

▬ Your child’s Baptismal Certificate is required if he/she is going to prepare to receive a sacrament. ▬