Religious Education Registration

Child's father's contact information:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Father's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Father's emergency Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Father's Email REQUIRED Please fill out this field. Please enter an email address.

Child's mother's contact information:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Street Address (if different from above): Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Mother's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Mother's emergency Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Mother's Email REQUIRED Please fill out this field. Please enter an email address.

Mother's Religion REQUIRED Please fill out this field. Please enter valid data.

Father's Religion REQUIRED Please fill out this field. Please enter valid data.

Is your family a member of Holy Cross or Our Lady of Grace Parishes? REQUIRED Yes No Please fill out this field.

If no, what church do you attend?

Catholic Community of Colchester