Religious Education Registration Form

Religious Education Registration Form
Student 1 *

First Name Middle Name Last Name
Birth Date *

Month Day Year
Grade *
Food Allergies? *

Yes No
If yes please indicate
Please let us know if there are any special ways we can accomodate your child's learning needs in Religious Education
Student 2

First Name Middle Name Last Name
Birth Date

Month Day Year
Grade
Food Allergies?

Yes No
If yes please indicate
Please let us know if there are any special ways we can accomodate your child's learning needs in Religious Education
Student 3

First Name Middle Name Last Name
Birth Date

Month Day Year
Grade
Food Allergies?

Yes No
If yes please indicate
Please let us know if there are any special ways we can accomodate your child's learning needs in Religious Education
Student 4

First Name Middle Name Last Name
Birth Date

Month Day Year
Grade
Food Allergies?

Yes No
If yes please indicate
Please let us know if there are any special ways we can accomodate your child's learning needs in Religious Education
Family Information
Mother's Name

First Name Last Name

Address *

Address (if different from Mother's)

Payment

1 Student $ 100.00

2 Students $ 175.00

3 Students $ 225.00

4 Students $ 275.00

Total $ 0.00

Family Information