*
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
*
required
Secondary Email
Primary Contact Cell Phone
*
required
Secondary Cell Phone
Home Street Address
*
required
City, State and Zip Code
*
required
As registered members of Little Flower Parish, please check your method of offertory
ParishSoft online giving
Envelopes
Family Emergency Information and Preferences
Emergency Contact Name
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required
Emergency Contact Phone Number
*
required
Religious Ed Directory
If you prefer that your family's contact information is NOT shared with other Religious Ed famlies, please opt out by checking below.
Opt out of published directory
Photo/Video Permission
If you prefer that photos and/or videos of your child(ren) are not used in parish communications, please opt out by checking below.
Opt out of photos/videos
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 gender
Female
Male
Child's School
*
required
Child's Grade as of September
*
required
Please Select…
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
Has he/she received First Communion?
Yes
No
Any learning challenges, health issues or allergies the teacher should know about?
1 WOULD YOU LIKE TO REGISTER ANOTHER CHILD FOR 8th GRADE 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 gender
Female
Male
Child's School
*
required
Child's Grade as of September
*
required
Please Select…
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
Has he/she received First Communion?
Yes
No
Any learning challenges, health issues or allergies the teacher should know about?
Total Cost
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