Parent/Guardian Information

Which Parish do you belong to? *

St. Emily

Other Other

Are you registered at your parish? * 🛈

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? *