Please enable JavaScript in your browser to complete this form.Confirmation Registration Form 2021-2022 (Sunday Only)12:30-2:00 p.m. in the Education Center $40.00 for the program. Please Choose 1 for Session: *In Class Sessions: At home Learning (online)Students Name: *Grade : 7 8 9 (up to age 14)Date of Birth: *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920City and State of Birth:Current Address:City:State:zip:Age:SchoolLanguage spoken in home:Baptized?YesNoChurch, City and State:Date of Baptism:DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Copy of your child’s baptism record?YesNo1st Eucharist? Yes NoChurch, City and State: Date of 1st Eucharist:DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Copy of your child’s 1st Eucharist record? YesNoParents Information:Father’s Name: *Religion:Address (if different from above):Phone *Cell:Mother’s Name: *Religion:Address (if different from above):PhoneCell:Main Language spoken in the home:Who is authorized to pick up your child? (other than parent)Emergency contact : NamePhoneEmail Address contact (must have): *Parents Registered at St. Joseph’s Parish? *YesNoI understand that all fees need to be in by December 5th 2021(parent signature)I understand that if my child misses more than 6 classes, my child will be dropped from the program, no refund will be given(parent signature)May we use your child’s photograph on our website? *YesNoFor Admin Only:*Program FEE:40.00 per childCashCheckFile Upload Click or drag a file to this area to upload. Submit