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St. Michael Catholic Church Parish Religious Education Program (PREP) Registration 2010-2011

Family Name *

Parent Information:

Father's First Name and Last Name

Father's Religion

Father's Email

Father's Phone - Home, Work and Cell

Mother's First Name and Last Name

Mother's Religion

Mother's Email

Mother's Phone - Home, Work and Cell

Guardian's Name (if applicable)

Child(ren) Lives with Both Parents Father Mother

Children Lives with Someone Else

Child(ren) Street Address

City

Zip

Correspondence will be sent to home address of the child, unless otherwise indicated.

STUDENT INFORMATION

Include for each student: Student First Name, Last Name, Male or Female (M,F), Birthdate, School, Grade, Sacraments Received: Baptism, 1st Reconciliation, 1st Communion - (B,1r,1c) -->Click on enter twice (so that there is a gap) after each child's information.

Please explain any allergies your child has. Include the name of the child and the allergy.

Please explain any physical, social or learning disability need your child has.