Parent/Guardian Information

Which Parish do you belong to? *

St. Emily

Other Other

Are you registered at your parish? (To receive our Parishioner Tuition Rate, you need to be registered at any Catholic parish in the area. Being registered means that you have completed any necessary registration forms at your parish, and you either receive donation envelopes or donate regularly electronically.) *

Yes

No

First Parent/Guardian's Name (First/Last) *

Phone Number *

Email Address *

Relationship to Child(ren) *

Address *

City *

State *

Zip Code *

Second Parent/Guardian's Name (First/Last)

Phone Number

Email Address

Relationship to Child(ren)

Same Street Address as First Parent/Guardian?

Yes

No

Address

City

State

Zip Code

Family Information

Child(ren) reside(s) with: *

Mother's Maiden Name (for sacramental purposes) *

How many children are you registering in our program this year? *