Prince of Peace Parish |

Date REQUIRED Please fill out this field. Please enter a date.

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

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

Date of Birth REQUIRED Please fill out this field. Please enter a date.

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.

Any Allergies REQUIRED Yes No Please fill out this field.

If Yes, please list Please enter valid data.

Does your child have any special needs? If yes, please explain REQUIRED Please fill out this field. Please enter valid data.

PARENT'S INFORMATION

Father's Name Please enter valid data.

Catholic Yes No

Mother's Name Please enter valid data.

Catholic Yes No

SACRAMENTS REQUIRED Baptism Yes No Please fill out this field.

Parish / Church & Date REQUIRED Please fill out this field. Please enter valid data.

First Communion First Communion Yes No

Parish / Church & Date Please enter valid data.

Confirmation Confirmation Yes No

Parish / Church & Date Please enter valid data.

SPONSORS REQUIRED Please fill out this field.

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

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

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

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

REGISTRATION FEE: $10.00 for 1 student, $20.00 for 2 siblings, $25.00 for 3+ siblings REQUIRED Please fill out this field.

EMERGENCY 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.

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

Relationship to Child Please enter valid data.

ADDITIONAL INFORMATION / COMMENTS

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

Date REQUIRED Please fill out this field. Please enter a date.

Prince of Peace Parish