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Required
Family Information
Mother's First Name
*
required
Mother's Maiden Name
*
required
Mother's Last Name
*
required
Mother's Religion
Father's First Name
*
required
Father's Last Name (Including Suffix Jr., III, IV)
*
required
Father's Religion
Primary Contact Email
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required
Secondary Email
Primary Contact Cell Phone
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required
Secondary Cell Phone
Home Street Address
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required
City, State and Zip Code
*
required
As registered members of Little Flower Parish, please check your method of offertory
Faith Direct
Envelopes
Family Emergency Information
Emergency Contact Name
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required
Emergency Contact Phone Number
*
required
Student Information
Child's First Name (legal name)
*
required
Child's Middle Name
Child's Nickname
Child's Last Name (Including Suffix Jr., III, IV)
*
required
Child's Date of Birth (m/d/y)
*
required
Child's School
*
required
Child's Grade as of September
*
required
Please Select…
K
1
2
3
4
5
6
7
8
Child's Date of Baptism (month/year)
*
required
Child's Church of Baptism
*
required
Child's Church of Baptism - Street Address
Child's Church of Baptism - City, State, Zip
Child's Date of First Communion - month/year (if applicable)
Child's Church of First Communion (if applicable)
Any learning challenges, health issues or allergies the teacher should know about?
1 WOULD YOU LIKE TO REGISTER ANOTHER CHILD FOR RELIGIOUS ED?
NO
YES
2 - Student Information
Child's First Name (legal name)
*
required
Child's Middle Name
Child's Nickname
Child's Last Name (Including Suffix Jr., III, IV)
*
required
Child's Date of Birth (m/d/y)
*
required
Child's School
*
required
Child's Grade as of September
K
1
2
3
4
5
6
7
8
Child's Date of Baptism (month/year)
*
required
Child's Church of Baptism
*
required
Child's Church of Baptism - Street Address
Child's Church of Baptism - City, State, Zip
Child's Date of First Communion - month/year (if applicable)
Child's Church of First Communion (if applicable)
Any learning challenges, health issues or allergies the teacher should know about?
2 WOULD YOU LIKE TO REGISTER ANOTHER CHILD FOR RELIGIOUS ED?
NO
YES
3 - Student Information
Child's First Name (legal name)
*
required
Child's Middle Name
Child's Nickname
Child's Last Name (Including Suffix Jr., III, IV)
*
required
Child's Date of Birth (m/d/y)
*
required
Child's School
*
required
Child's Grade as of September
K
1
2
3
4
5
6
7
8
Child's Date of Baptism (month/year)
*
required
Child's Church of Baptism
*
required
Child's Church of Baptism - Street Address
Child's Church of Baptism - City, State, Zip
Child's Date of First Communion - month/year (if applicable)
Child's Church of First Communion (if applicable)
Any learning challenges, health issues or allergies the teacher should know about?
3 WOULD YOU LIKE TO REGISTER ANOTHER CHILD FOR RELIGIOUS ED?
NO
YES
4 - Student Information
Child's First Name (legal name)
*
required
Child's Middle Name
Child's Nickname
Child's Last Name (Including Suffix Jr., III, IV)
*
required
Child's Date of Birth (m/d/y)
*
required
Child's School
*
required
Child's Grade as of September
K
1
2
3
4
5
6
7
8
Child's Date of Baptism (month/year)
*
required
Child's Church of Baptism
*
required
Child's Church of Baptism - Street Address
Child's Church of Baptism - City, State, Zip
Child's Date of First Communion - month/year (if applicable)
Child's Church of First Communion (if applicable)
Any learning challenges, health issues or allergies the teacher should know about?
4 WOULD YOU LIKE TO REGISTER ANOTHER CHILD FOR RELIGIOUS ED?
NO
YES
5 - Student Information
Child's First Name (legal name)
*
required
Child's Middle Name
Child's Nickname
Child's Last Name (Including Suffix Jr., III, IV)
*
required
Child's Date of Birth (m/d/y)
*
required
Child's School
*
required
Child's Grade as of September
K
1
2
3
4
5
6
7
8
Child's Date of Baptism (month/year)
*
required
Child's Church of Baptism
*
required
Child's Church of Baptism - Street Address
Child's Church of Baptism - City, State, Zip
Child's Date of First Communion - month/year (if applicable)
Child's Church of First Communion (if applicable)
Any learning challenges, health issues or allergies the teacher should know about?
Total Cost
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