Family Last Name:
His First:		Her First:
Address:		City:
Zip:
Phone:		E-mail:
His Work #:		Her Work #:
Alternate Emergency #:

This is a registration for:
(Please check the one answer that applies, and then scroll down or click here to fill in the information on each child.)

Individual	Couple
Family with 1 child	Family with 2 children
Family with 3 children	Family with 4 + children

Please include info for All children, including infants and toddlers under age 3 - staffing requires a definite head count.
All Gatherings include a simple shared meal.
Please select a gathering day/time:

Wednesday 6:00 - 8:30 PM	Friday 6:00 - 8:30 PM
Sunday 4:45 - 7:15 PM

Click here to view a list of gathering dates, prices and topics for 2010-2011.
If you need to change your Gathering Day, Please notify the office in advance ...urgent changes only please.

Necessary Information about each child.
#1	Name:	DOB:	Age:	Grade:	Gathering Day:
Does your child have allergies or special needs?
Sacraments already received: Baptism Reconciliation Communion Confirmation
Sacraments needed this year:

#2	Name:	DOB:	Age:	Grade:	Gathering Day:
Does your child have allergies or special needs?
Sacraments already received: Baptism Reconciliation Communion Confirmation
Sacraments needed this year:

Necessary Information about each child.
#3	Name:	DOB:	Age:	Grade:	Gathering Day:
Does your child have allergies or special needs?
Sacraments already received: Baptism Reconciliation Communion Confirmation
Sacraments needed this year:

Necessary Information about each child.
#4	Name:	DOB:	Age:	Grade :	Gathering Day:
Does your child have allergies or special needs?
Sacraments already received: Baptism Reconciliation Communion Confirmation
Sacraments needed this year:

Necessary Information about each child.
#5	Name:	DOB:	Age:	Grade:	Gathering Day:
Does your child have allergies or special needs?
Sacraments already received: Baptism Reconciliation Communion Confirmation
Sacraments needed this year: