A Christian Community in the Roman Catholic Christian Tradition

Online Registration Form 2017

- Religious Education

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- Family Information
  
  Family name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's maiden name REQUIRED Please fill out this field. Please enter valid data.
  
  Guardian's name Please enter valid data.
- Contact information
  
  Email address REQUIRED Please fill out this field. Please enter an email address.
  
  Home phone REQUIRED Please fill out this field. Please enter valid data.
  
  Father's cell Please enter valid data.
  
  Mother's cell Please enter valid data.
  
  Street address REQUIRED Please fill out this field. Please enter valid data.
  
  City (if not Pasadena) Please enter valid data.
  
  Zip REQUIRED Please fill out this field. Please enter valid data.
- Child 1
  
  Child's name REQUIRED Please fill out this field. Please enter valid data.
  
  Child's DOB REQUIRED Please fill out this field. Please enter valid data.
  
  Child's school REQUIRED Please fill out this field. Please enter valid data.
  
  Child's grade REQUIRED Please fill out this field. Please enter valid data.
  
  Sacrament Registration REQUIRED Please fill out this field.
  
  Medical/School concerns
  (please provide detailed information concerning any allergies, medical conditions or special learning situations)
- Child 2
  
  Child's name Please enter valid data.
  
  Child's DOB Please enter valid data.
  
  Child's school Please enter valid data.
  
  Child's grade Please enter valid data.
  
  Sacrament Registration REQUIRED Please fill out this field.
  
  Medical/School concerns
  (please provide detailed information concerning any allergies, medical conditions or special learning situations)
- Child 3
  
  Child's name Please enter valid data.
  
  Child's DOB Please enter valid data.
  
  Child's school Please enter valid data.
  
  Child's grade Please enter valid data.
  
  Sacrament Registration REQUIRED Please fill out this field.
  
  Medical/School concerns
  (please provide detailed information concerning any allergies, medical conditions or special learning situations)
- Child 4
  
  Child's name Please enter valid data.
  
  Child's DOB Please enter valid data.
  
  Child's school Please enter valid data.
  
  Child's grade Please enter valid data.
  
  Sacrament Registration REQUIRED Please fill out this field.
  
  Medical/School concerns
  (please provide detailed information concerning any allergies, medical conditions or special learning situations)
- Child 5
  
  Child's name Please enter valid data.
  
  Child's DOB Please enter valid data.
  
  Child's school Please enter valid data.
  
  Child's grade Please enter valid data.
  
  Sacrament Registration REQUIRED Please fill out this field.
  
  Medical/School concerns
  (please provide detailed information concerning any allergies, medical conditions or special learning situations)
- Other Information
  
  If you are divorced or separated are there any custody arrangements that we should be aware of?
  
  I want to home school my child(ren) REQUIRED Yes No Please fill out this field.
  
  Tuition payment option REQUIRED Please fill out this field.
  
  Parish Envelope number REQUIRED Please fill out this field. Please enter valid data.
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Our Lady of the Chesapeake

All are welcome!

Online Registration Form 2017