St. joseph the worker church First reconciliation/first communion registration 2009-2010

Child’s Name: ___________________________________________________

 

Father’s Name: __________________________________________________

 

Mother’s Maiden Name: ___________________________________________

 

Date of Birth: ____________________________________________________

 

Date of Baptism: _________________________________________________

 

Place of Baptism: ________________________________________________

Please fill form out completely so that the Sacrament can be recorded.

 

If your child was NOT baptized in this Parish you must attach a copy of the Baptismal Certificate to the registration form.

 

Registration Fee $55.00

Out of Parish Fee is an additional $25.00 per child

 

(Please contact the Director of Religious Education if financial assistance is needed)

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Office Use Only

Received by ______ Amt Paid ______ Date Paid ______ Ck # ______ Cash ______

 

Baptism Certificate Copy Attached Y / N

 

Baptism at St. Joseph the Worker Verified Y / N