Name of person filling out this registration form? REQUIRED Please fill out this field. Please enter valid data.

New family or continuing education? Continuing means your child attended classes in 2018-2019. REQUIRED Please fill out this field.

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Father's Contact Number Please enter a phone number.

Mother's Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Contact Number Please enter a phone number.

Who should first be contacted in the event of a question or concern? Mother Father Other

Who does the child primarily live with? Mother Father Both Other

If other, please provide name, your relationship to child, and a contact number. Please enter valid data.

Address where child lives? REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Parish Where Registered Blessed Sacrament Our Lady Queen Of Peace Other

If other, please provide Church name and city Please enter valid data.

Student Information

Student's Last and First Name REQUIRED Please fill out this field. Please enter valid data.
Student's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
Student's Gender Male Female
Student's Grade as of September 2019 REQUIRED Please fill out this field.
Has your child been Baptized? Yes No
If yes, what was approximately the date? Please enter valid data.
Parish where Baptized? Please enter valid data.
Has your child completed their 1st Reconciliation? Yes No
If yes, what approximately was the date? Please enter valid data.
Parish where 1st Reconciliation was completed? Please enter valid data.
Has your child received their First Eucharist? Yes No
If yes, what approximately was the date? Please enter valid data.
Parish where 1st Eucharist was received? Please enter valid data.
Emergency Contact Information (This must be a non-parent who could pick up child if necessary)

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

Relationship to child REQUIRED Please fill out this field. Please enter valid data.

Phone REQUIRED Please fill out this field. Please enter valid data.

Anything we need to know? REQUIRED Please fill out this field.

Registration Fees

1 child= $50
2 children= $90
3 children= $120
4 children= $140

*Note that this does not include any additonal potential fees such as retreats

I would like to learn about tuition assistance. Yes No

All done? Click submit.

Blessed Sacrament

Catholic Church & School