RE Program 2019-2020 Registration Form

Kindergarten - 5th Grade

You must be a registered family at St. Pius to register for Religious Education, or have a letter of permission from your parish where you are registered.
Only one registration form per family is required for K-5th grade.

Please complete the information for each of the children who will be attending Religion Education K-5 on Sunday morning.

Family Contact Information

FAMILY LAST NAME ON PARISH REGISTRATION

Required*

Address

Street 1*

Street 2

City*

State*

Zip*

Primary Phone

Required* --

FATHER'S INFORMATION

Name

Title

First Name*

Middle Name

Last Name*

Religion

Required*

E-mail

Cell phone #

MOTHER'S INFORMATION

MAIDEN Name

Title

First Name*

Middle Name

Last Name*

Religion

Required*

E-mail

Required*

Cell phone #

Required* --

Emergency Contact

Name

First Name*

Last Name*

Person to be reached during Religious Ed

Relationship to child

Required*

Emergency Phone Number

Required* --

Family Background

Parents are

Required*

Children live with

Required*

Family Ethnicity

Required for annual Census

	African American
	Asian American
	Caucasian

	Hispanic or Latino
	Native American
	Other (please specify)

If other

Permission

I give St.Pius X Church permission to print my child's name in the church bulletin or sacramental booklets	Required*
I give permission for pictures and/or video of my child/children (named in this form) engaged in activities related to RE or parish event to have their pictures posted in St.Pius X publications or websites.	Names of participants will not be used without expressed permission from the parent or guardian. *
If no box is checked the Diocese of Richmond and St.Pius X assumes you give permission.

Student 1

New registration of students requires Baptismal Certificate if Baptism was not done at St. Pius X.

Child's Name

Title

First Name*

Middle Name

Last Name*

Birth Date

Required* //

Gender
Required*

	Male
	Female

Grade 2019-2020

Required*

School 2019-2020

Required*

Sacraments Completed
Required*

	Baptism
	First Penance
	First Communion

Church, City, State, Country of Child's Baptism

Required*

Special Requests/Needs

Medical Condition or Allergies

Student 2

New registration of students requires Baptismal Certificate if Baptism was not done at St. Pius X.

Child's Name

Title

First Name

Middle Name

Last Name

Birth Date

Gender

	Male
	Female

Grade 2019-2020

Sacraments Completed

	Baptism
	First Penance
	First Communion

Church, City, State, Country of Child's Baptism

Special Requests/Needs

Medical Condition or Allergies

Student 3

New registration of students requires Baptismal Certificate if Baptism was not done at St. Pius X.

Child's Name

Title

First Name

Middle Name

Last Name

Birth Date

Gender

	Male
	Female

Grade 2019-2020

Sacraments Completed

	Baptism
	First Penance
	First Communion

Church, City, State, Country of Child's Baptism

Special Requests/Needs

Medical Condition or Allergies

Please Note

THERE IS NO CHARGE FOR ST.PIUS X RELIGIOUS EDUCATION PROGRAMS. Though, we do require you make the following commitments:

I will contribute financially to St. Pius X Parish to the best of my ability.
Required*

I will

I will offer my time and talents in the following way(s) Check at least one:
Required*

Name of the Person completing this form

Title

First Name*

Middle Name

Last Name*

Parent Signature
Required*

I acknowledge that as the parent/guardian, this information will be submitted to the parish for use in registration.*

Yes

© 2017-2019 St. Pius X Parish Catholic Church | 7800 Halprin Drive, Norfolk VA 23518
PHONE: 757-583-0291 | FAX: 757-583-0293

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RE Program 2019-2020 Registration Form

Kindergarten - 5th Grade

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