EmailMeForm
2017-2018 Religious Education Registration
Catholic Center @ UGA
1344 S. Lumpkin Street
Athens, GA 30605-1344
Date
*
MM
/
DD
/
YYYY
Father's Name
*
First
Last
Mother's Name
*
First
Last
Custodial Parent (if different from above)
Home Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Home Phone
*
###
-
###
-
####
Father's Work/Cell Phone
*
###
-
###
-
####
Mother's Work/Cell Phone
*
###
-
###
-
####
Email address
*
Emergency Contact
*
Both Parents Catholic?
*
Yes
No
INFORMATION: CHILD #1
Note: If any of your children were baptized outside of this community and you have not already supplied us with a copy of each child's baptismal record, you will need to supply a copy for our files.
Child's Name
First
Last
Date of Birth
MM
/
DD
/
YYYY
Gender
*
Male
Female
Grade
*
Session
Room
Class
Baptismal Date
MM
/
DD
/
YYYY
Baptized Catholic?
Yes
No
First Eucharist Date
MM
/
DD
/
YYYY
First Reconciliation Date
MM
/
DD
/
YYYY
Confirmation Date
MM
/
DD
/
YYYY
Special needs (medical, learning disabilities, physical disabilities)
INFORMATION: CHILD #2
Note: If any of your children were baptized outside of this community and you have not already supplied us with a copy of each child's baptismal record, you will need to supply a copy for our files.
Child's Name
First
Last
Date of Birth
MM
/
DD
/
YYYY
Gender
Male
Female
Grade
Session
Room
Class
Baptismal Date
MM
/
DD
/
YYYY
Baptized Catholic?
Yes
No
First Eucharist Date
MM
/
DD
/
YYYY
First Reconciliation Date
MM
/
DD
/
YYYY
Confirmation Date
MM
/
DD
/
YYYY
Special needs (medical, learning disabilities, physical disabilities)
INFORMATION: CHILD #3
Note: If any of your children were baptized outside of this community and you have not already supplied us with a copy of each child's baptismal record, you will need to supply a copy for our files.
Child's Name
First
Last
Date of Birth
MM
/
DD
/
YYYY
Gender
Male
Female
Grade
Session
Room
Class
Baptismal Date
MM
/
DD
/
YYYY
Baptized Catholic?
Yes
No
First Eucharist Date
MM
/
DD
/
YYYY
First Reconciliation Date
MM
/
DD
/
YYYY
Confirmation Date
MM
/
DD
/
YYYY
Special needs (medical, learning disabilities, physical disabilities)
INFORMATION: CHILD #4
Note: If any of your children were baptized outside of this community and you have not already supplied us with a copy of each child's baptismal record, you will need to supply a copy for our files.
Child's Name
First
Last
Date of Birth
MM
/
DD
/
YYYY
Gender
Male
Female
Grade
Session
Room
Class
Baptismal Date
MM
/
DD
/
YYYY
Baptized Catholic?
Yes
No
First Eucharist Date
MM
/
DD
/
YYYY
First Reconciliation Date
MM
/
DD
/
YYYY
Confirmation Date
MM
/
DD
/
YYYY
Special needs (medical, learning disabilities, physical disabilities)
Powered by
EMF
Web Form
Report Abuse
