St. Paul Religious Education Program

Registration Form 2008 - 2009

Name of Parents/Guardians______________________________________________________

Address ___________________________________________________________________

Street City Zip

Home Phone #___________________________________

(m)Cell Phone # _________________________ (m)Email address: _________________________

(f)Cell Phone # __________________________ (f)Email address: _________________________

Child(ren) lives with: ____Parents ____Mother ____Father ____Other (please describe)______________

uStudent Name ______________________________________________ School_________________

Birth date________________ Current Grade ______

Food Allergies___________________________ Disabilities/Comments___________________________

vStudent Name _______________________________________________ School ________________

Birth date________________ Current Grade ______

Food Allergies___________________________ Disabilities/Comments__________________________

wStudent Name _______________________________________________ School ________________

Birth date________________ Current Grade ______

Food Allergies___________________________ Disabilities/Comments___________________________

xStudent Name ______________________________________________ School_________________

Birth date________________ Current Grade ______

Food Allergies___________________________ Disabilities/Comments___________________________

If above guardian cannot be reached in an emergency, please provide a second contact:

Name ___________________________________________ Phone_______________________

Relationship to child __________________________________ Cell/Pager _______________________