SAINT FRANCIS XAVIER AND SAINT THERESA, THE LITTLE FLOWER
RELIGIOUS EDUCATION REGISTRATION
2008-2009
PARISH_________________________________________________________________________________________________
FAMILY NAME________________________________________________HOME PHONE______________________________
FATHER____________________________MOTHER (INCLUDE MAIDEN NAME)________________________________________
ADDRESS__________________________________________ TOWN/ZIP CODE______________________________________
FATHER’S WORK #__________________________________MOTHER’S WORK #___________________________________
FATHER’S CELL #___________________________________MOTHER’S CELL #____________________________________
E-MAIL ADDRESS________________________________________________________________________________________
EMERGENCY NAME & #___________________________________________________________________________________
CHILD # ONE Male - Female
CHILD’S NAME________________________________________DATE OF BIRTH__________________________________
REL. ED. GRADE IN SEPTEMBER 2008____________________SCHOOL ATTENDING______________________________
SACRAMENTS RECEIVED TO DATE: BAPTISM_____FIRST EUCHARIST_____PENANCE_____CONFIRMATION_____
ALLERGIES OR SPECIAL EDUCATIONAL NEEDS_____________________________________________________________
CHILD’S NAME________________________________________DATE OF BIRTH__________________________________
REL. ED. GRADE IN SEPTEMBER 2008____________________SCHOOL ATTENDING______________________________
SACRAMENTS RECEIVED TO DATE: BAPTISM_____FIRST EUCHARIST_____PENANCE_____CONFIRMATION_____
ALLERGIES OR SPECIAL EDUCATIONAL NEEDS_____________________________________________________________
CHILD’S NAME________________________________________DATE OF BIRTH__________________________________
REL. ED. GRADE IN SEPTEMBER 2008____________________SCHOOL ATTENDING______________________________
SACRAMENTS RECEIVED TO DATE: BAPTISM_____FIRST EUCHARIST_____PENANCE_____CONFIRMATION_____
ALLERGIES OR SPECIAL EDUCATIONAL NEEDS_____________________________________________________________
CHILD #FOUR Male - Female
CHILD’S NAME________________________________________DATE OF BIRTH___________________________________
REL. ED. GRADE IN SEPTEMBER 2008____________________SCHOOL ATTENDING_______________________________
SACRAMENTS RECEIVED TO DATE: BAPTISM_____FIRST EUCHARIST_____PENANCE_____CONFIRMATION______
ALLERGIES OR SPECIAL EDUCATIONAL NEEDS_____________________________________________________________
REGISTRATION FEE: $50 PER CHILD, Make checks payable to: St. Francis Xavier Parish or St. Theresa Parish