Online Registration FORM

• online registration form for religious ed

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  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Street Address REQUIRED Please fill out this field. Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • Main Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.
  • Main contact email address REQUIRED Please fill out this field. Please enter valid data.
  • Family is currently registered at what parish? Please enter valid data.
  • Religious Education Program child/ren were enrolled in last year? Please enter valid data.
  • Who has physical custody of the child? REQUIRED Mother Father Mother and Father Grandparent Please fill out this field.
  • Parent One Full Name REQUIRED Please fill out this field. Please enter valid data.
  • Parent One Phone Number REQUIRED Please fill out this field. Please enter valid data.
  • Parent One Email REQUIRED Please fill out this field. Please enter valid data.
  • Parent One Religion Roman Catholic Other
  • Parent One Occupation Please enter valid data.
  • Parent Two Full Name Please enter valid data.
  • Parent Two Phone Number Please enter valid data.
  • Parent Two Email Please enter valid data.
  • Parent Two Religion Roman Catholic Other
  • Parent Two Occupation Please enter valid data.
  • Child 1 Full Baptismal Name: REQUIRED Please fill out this field. Please enter valid data.
  • Child 1 Gender REQUIRED Please fill out this field. Please enter valid data.
  • Child 1 Birth Date REQUIRED Please fill out this field. Please enter valid data.
  • Child 1 Grade and School in Fall: REQUIRED Please fill out this field. Please enter valid data.
  • Child 2 Full Baptismal Name: Please enter valid data.
  • Child 2 Gender: Please enter valid data.
  • Child 2 Birth Date Please enter valid data.
  • Child 2 Grade and School in Fall Please enter valid data.
  • Child 3 Full Baptismal Name: Please enter valid data.
  • Child 3 Gender Please enter valid data.
  • Child 3 Birth Date: Please enter valid data.
  • Child 3 Grade and School in the Fall Please enter valid data.
  • Tell us what you would like us to know about your child.
  • I give permission to St. Ambrose to use photographs of my child/ren in church publications. Yes No
  • If yes, type full name here to serve as signature Please enter valid data.
  • I give permission to give my main contact phone number and email to my child/ren's catechist. Yes No
  • If yes, type full name here to serve as signature. Please enter valid data.
  • To receive a confirmation email that this form was submitted successfully, you must include your email address in the box below:
  • Email REQUIRED Please fill out this field. Please enter an email address.

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