RELIGIOUS EDUCATION REGISTRATION – Saint Leo the Great Parish

ST. LEO THE GREAT PARISH

ASHLEY, PA

RELIGIOUS EDUCATION REGISTRATION FORM

AM REGISTERING MY CHILD FOR THE FOLLOWING: (Please check all that apply.)

CCD Classed

First Penance

First Communion

Confirmation

STUDENT’S NAME

First Last

STUDENT’S ADDRESS

Street Address City State ZIP Code

STUDENT’S EMAIL ADDRESS

STUDENT’S DATE OF BIRTH

PLACE OF BIRTH

STUDENT’S PRESENT SCHOOL AND GRADE

CHURCH & DATE OF STUDENT’S BAPTISM

(Within two weeks, please submit a copy of your child’s Baptismal certificate if he/she was not baptized in this parish.)

CHURCH & DATE OF STUDENT’S FIRST PENANCE

CHURCH & DATE OF STUDENT’S FIRST COMMUNION

IS THE STUDENT A MEMBER OF THE PARISH

(If the student is not a member of this parish, a letter from the child’s current pastor which allows for religious instruction at St. Leo the Great Church must be sent to Father Dang within two weeks. The letter must also indicate the dates of the child’s attendance at the home parish’s religious education program.)

WHERE DID THE STUDENT ATTEND RELIGIOUS INSTRUCTION

PLEASE LIST ANY CONDITIONS WHICH MAY AFFECT STUDENT’S ATTENDANCE OR CLASSROOM CONDUCT

PARENT/GUARDIAN’S NAME

First Last

PARENT/GUARDIAN’S ADDRESS

Street Address City State ZIP Code

PARENT/GUARDIAN’S PHONE

PARENT/GUARDIAN’S EMAIL ADDRESS

ARE YOU A MEMBER OF ST. LEO THE GREAT PARISH?

EMERGENCY CONTACT NAME

First Last

EMERGENCY CONTACT PHONE

RELATION TO STUDENT