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Family Name: _________________________________
Address:
_________________________________
Phone: _________________________________
E-Mail:
_________________________________
Choice of Session Each Month
(Please circle one)
Sat-After Mass Weds-6:00 PM
Family
Member
Information
Head(s) of
Household
Religion
Male:
___________________________________________
_________
first
last
Female:
___________________________________________
_________
first
(maiden)
last
Name
DOB
Grade School
Child 1: ____________________
__________ ______ ________________
Child 2: ____________________
__________ ______ ________________
Child 3: ____________________
__________ ______ ________________
Child 4: ____________________
__________ ______ ________________
Child 5: ____________________
__________ ______ ________________
Registration is $60 per family. Seniors or single adults fee is
$35.
Additional Fee of $15 for 1st Communion
Prep & Confirmation Prep
Amount enclosed: $_______________
(no one is refused because
of no fee)
If
you want to help: I can help with
__________________________
(please
print this out, add your information and send it to the address
below
or, drop it off at the Church or Rectory by August
27th)
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