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Faith Formation Registration

- Faith Formation Registration
  2022-2023
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Student Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth (Month/Day/Year) REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth (City, State) REQUIRED Please fill out this field. Please enter valid data.
  
  School Attending REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level 2022-2023 REQUIRED Please fill out this field.
  
  Sacraments Received Date and Place
  
  Reconciliation Please enter valid data.
  
  First Holy Communion Please enter valid data.
  
  Parent Information
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Father's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mother's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Emergency Contact - Call First
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Student REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Emergency Contact - Call Second
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Student REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Emergency Contact - Call Third
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Student REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Health Insurance
  
  Name of Insurance Please enter valid data.
  
  Group Number Please enter valid data.
  
  Member Number Please enter valid data.
  
  Medical
  
  Allergies Please enter valid data.
  
  Medical Conditions Please enter valid data.
  
  If it is not possible to contact any of the above listed, I hereby authorize transportaion to the nearest medical facility for such an emergency medical treatment as deemed necessary for the safety and protection of my child, but not at the expense of St. Bernadette.
  I Agree Please select this field.
  
  Submit
  
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- Contact Us
  
  Sister Catherine Diaz
  
  Director of Faith Formation/Liturgical Coordinator
  
  (209)490-4219

St. Bernadette's Catholic Church

ALL ARE WELCOME!

Faith Formation Registration

Faith Formation Registration
2022-2023

Contact Us