registration Form for Pre-k - 6th grade - Holy Family Catholic Church

Head of Household

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

Last Name 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.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.

Spouse

First Name Please enter valid data.

Last Name Please enter valid data.
City Please enter valid data.

State

Zip Please enter a zip code.
Phone Number Maximum 20 characters Please enter a phone number.
Email Please enter an email address.

Marital Status of Parents:

Child resides with:

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

Children must be four years old on/or before September 1st to Register for the Pre-K class. A Baptism Certificate must be submitted for children preparing to receive First Communion and Confirmation.

EMERGENCY CONTACTS: Please note below the person(s) to contact in case it becomes necessary to call you while your child is in class or attending an event.

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 Maximum 20 characters Please fill out this field. Please enter a phone number.
Relationship to Child Please enter valid data.
First Name Please enter valid data.

Last Name Please enter valid data.
Phone Number Maximum 20 characters Please enter a phone number.
Relationship to Child Please enter valid data.

THE FOLLOWING STATEMENT MUST BE CHECKED BY A PARENT OR LEGAL GUARDIAN:

In the event of a health emergency that requires immediate medical attention, I give permission to transport my child to a hospital for emergency treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

I Agree Please select this field.

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