Student’s Name_________________________________________________________________________________

Faith Formation Grade level ___________________ Date of Birth _____________________________________

Street Address___________________________________ City and Zip Code_______________________________

Home Telephone _____________________ Email address: _____________________________________________

To whom shall we address correspondence regarding the participant? ______________________________________

Mother’s Name_______________________________________________ Religion__________________________

Father’s Name______________________________________________ Religion ___________________________

Telephone Number(s): _______________________________________ ___________________________________

Name of participant’s school _________________________________________ Grade Level __________________

Is the student new to the Sacred Heart Faith Formation Program? Yes No

(If yes, please list the name and place of previous Catholic school or parish religious education program(s).

____________________________________________________________________________________________

Place and date of Baptism ______________________________________________________________________

Place and date of First Eucharist _________________________________________________________________

Place and date of First Reconciliation ______________________________________________________________

Is there any information that you would like us to know about your child? Any physical, emotional, family, or learning

difficulties? Are there any specific health or medical issues we should be aware of? (All information will be treated with

confidentiality.)

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Please check those areas in which you, as a parent, are interested in helping with:

___ Working as a classroom aide

___ Parking lot monitor

___ Special occasions

___ Advent Program

Other skills or talents you may have:

__ ________________________________

__ ________________________________

Please check program fee that applies: