New Student Education Registration

NOTICE: A completed Consent to Treat form must accompany this form.

Registration fee is $50 per Family if registered as Parishioners, $75 per Family if not. Please place a check in the collection basket or mail it to the office ATTN: Joan.

Child Information
Child's Name:
Gender: Male   Female
Is the family registered as parishioners of St Fidelis Parish? Yes   No

Parental Information
Father's First and Last Name: Religion:
Mother's Name: Mother's Maiden Name:
Marital Status: Married   Divorced   Single   Widowed  
With whom does the student live, and which parent must be contacted for illness or events?
Address: City:
State: Zip:
Home Phone: Work Phone:
Email Address:
Choose one Sunday 9-10:15am   Sunday 6:30-8:30pm   Monday 6-7:15pm   Homeschool
Grade 2008-2009:
Date of Birth: Month: Day: Year:
City and State of Birth:
Date of Bapitism Church of Baptism:
Church Address City:
Church State Postal Code:
If your child was not baptized at Saint Fidelis, a copy of their Baptismal Certificate must be submitted with this registration.
Date of First Communion Church of First Communion:
Please describe any speech or learning disabilities:
Allergies?
Physical limitations?

Emergency Contact Person
Name: Phone Number: