Student Name*

First Nickname Last

Student Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Parent's Primary Email*

Date of Birth*

School Grade in Sept. 2020*

Rel. Ed. Grade in Sept. 2020*

Name of School for 2020-21*

Which program will you be attending:*

Would you like to add a second student?*

Yes
No

Second Student's Name*

First Nickname Last

Is the second students address the same?

Yes
No

Second Student's Address

Street Address Address Line 2 City State ZIP Code

Second Student's Home Phone*

Second Child's Date of Birth*

Second Student's School Grade in Sept. 2020*

Second Students Rel. Ed. Grade in Sept. 2020*

Second Student's Name of School for 2020-21*

Which program will the second student be attending:*

Would you like to add a third student?*

Yes
No

Is the third students address the same?

Yes
No

Third Student's Address

Street Address Address Line 2 City State ZIP Code

Third Student's Home Phone*

Third Child's Date of Birth*

Third Student's School Grade in Sept. 2020*

Third Students Rel. Ed. Grade in Sept. 2020*

Third Student's Name of School for 2020-21*

Which program will the third student be attending:*

Would you like to add a fourth student?*

Yes
No

Is the fourth students address the same?

Yes
No

Fourth Student's Address

Street Address Address Line 2 City State ZIP Code

Fourth Student's Home Phone*

Fourth Child's Date of Birth*

Fourth Student's School Grade in Sept. 2020*

Fourth Students Rel. Ed. Grade in Sept. 2020*

Fourth Student's Name of School for 2020-21*

Which program will the fourth student be attending:*

Would you like to add a fifth student?*

Yes
No

Is the fifth students address the same?

Yes
No

Fifth Student's Address

Street Address Address Line 2 City State ZIP Code

Fifth Student's Home Phone*

Fifth Child's Date of Birth*

Fifth Student's School Grade in Sept. 2020*

Fifth Students Rel. Ed. Grade in Sept. 2020*

Fifth Student's Name of School for 2020-21*

Which program will the fifth student be attending:*

Religious Education Registration 2020-21

Step 1 of 6

Father's Information

Mother's Information

Payment

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