Student's Name *

First Name

Last Name

Birthdate

MM

DD

YYYY

Student's Name

First Name

Last Name

Birthdate

MM

DD

YYYY

Student's Name

First Name

Last Name

Birthdate

MM

DD

YYYY

Student's Name

First Name

Last Name

Birthdate

MM

DD

YYYY

Family Contact Information *

Indicate if there has been a change of address or living situation. Please note that email is the primary form of contact between the RE program and families, if you have not received email updates this year, please be sure to update your email address here.

Address, phone number, and email remain the same.

Change of Address

Change of Phone Number

Change of Email Address

I give permission for Immaculate Conception and St. Joseph Parish Religious Education program to take and use photographs, video, and audio or other digital recordings of my child(ren) for public relations purposes, including, but not limited to, use on the parish website, facebook page, the Sunday bulletin, brochures or other publications produced by the Church. I understand that, in use of such materials, my child(ren)'s name(s) will not be disclosed. *

I agree.

I disagree.

The above information is accurate, and should there be a change to the child's registration status, health, or contact information I will contact the Director of Religious Education to inform her of the change.

I agree.

I disagree.