Faith Formation & Youth Ministry Registration Form – St. James & Our Lady of the Assumption

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Basic Information

Family Last Name*

Primary Phone No*

Father's Name*

Father's Phone*

Father's Email*

Mother's Name*

Mother's Phone*

Mother's Email*

Address*

Street Address Address Line 2 City State ZIP Code

Number of Children*

Please enter a number from 1 to 4.

Emergency Contact

Emergency Contact Name*

First Last

Emergency Contact Phone*

Relation to Child/ren*

Child 1 Information

Name of Child*

First Last

Date of Birth*

Grade*

Education Concerns

Sacraments Received*

Baptism
Reconciliation
First Eucharist
Confirmation

Baptism Date

Where They Were Baptized*

First Reconcilation Date

Where They Received First Reconciliation Church*

First Eucharist Date

Where They Received First Eucharist*

Confirmation Date

Where They Were Confirmed*

Child 2 Information

Name of Child*

First Last

Date of Birth*

Grade*

Education Concerns

Sacraments Received*

Baptism
Reconciliation
First Eucharist
Confirmation

Baptism Date

Where They Were Baptized*

First Reconcilation Date*

Where They Received First Reconciliation Church*

First Eucharist Date

Where They Received First Eucharist*

Confirmation Date

Where They Were Confirmed*

Child 3 Information

Name of Child*

First Last

Date of Birth*

Grade*

Education Concerns

Sacraments Received*

Baptism
Reconciliation
First Eucharist
Confirmation

Baptism Date

Where They Were Baptized*

First Reconcilation Date

Where They Received First Reconciliation Church*

First Eucharist Date

Where They Received First Eucharist*

Confirmation Date

Where They Were Confirmed*

Child 4 Information

Name of Child*

First Last

Date of Birth*

Grade*

Education Concerns

Sacraments Received*

Baptism
Reconciliation
First Eucharist
Confirmation

Baptism Date

Where They Were Baptized*

First Reconcilation Date

Where They Received First Reconciliation Church*

First Eucharist Date

Where They Received First Eucharist*

Confirmation Date

Where They Were Confirmed*

If you have more than four children, please fill out the form again!

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Name

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