New Family Religious Education Registration

New Family	Religious Education Registration School Year:_________ St. Mary of the Assumption P.O. Box 129 Cambridge, Vt 05444 (802) 644-5073
Family Name:	Father's Name:	Mother's Name:
Mailing Address:	Street Address:
City:		Zip:
Home Phone:	Emergency Phone:

Child's Name:		Date of Birth:
Grade:	Gender: Male / Female	Place of Birth:
Date of Baptism:	Name of Church:	Church Address:
Date of First Communion:	Name of Church:	Church Address:
Child's Special Interests:
Any Allergies?
Previous Religious Instruction: Yes / No	Where?
Child's Name:		Date of Birth:
Grade:	Gender: Male / Female	Place of Birth:
Date of Baptism:	Name of Church:	Church Address:
Date of First Communion:	Name of Church:	Church Address:
Child's Special Interests:
Any Allergies?
Previous Religious Instruction: Yes / No	Where?

* Use Back for additional registrations

How can you assist the Religious Education Program?

Catechist

Substitute Teacher

Teacher's Assistant

Cleanup after class

Other:_____________________

Registration Fee is $20 (1 child), $30 (2 children) or $40 per family
Make Checks payable to: St. Mary's Church and include payment with this application!

Signature:__________________________________________________ Date: ___________________

For Office use only:

Date Received:

Check Number:

Amount Received: