(Please fill in all boxes that apply and press the "submit button" at the bottom of the page.)
 Note:  Pressing the "Reset Button" clears all information previously entered and it will be necessary to start over.
All personal information is held in strict confidence.
 
 
FAMILY REGISTRATION:
Family ID # Today's Date

FAMILY NAME:		  
  Head of Household:
  Spouse/Significant Other:
  Last Name:
  First Name:
  Title:          
  Suffix:        
  Last Name:
  First Name:
  Title:
   
  Name Formats Used in Mailings:
  Mailing Name:         
  Informal Salutation:
  Formal Salutation:  

FAMILY  INFO:
  Registered:
  Family Status:
  Street Address, Line 1:
  Street Address, Line 2:
  Street City / State: Street Zip:
  Tel. Geo. Area Number:
 
Home Phone:       Unlisted:  Yes ;  No
Office Phone:       Unlisted:  Yes ;  No
Cell Phone:          Unlisted:  Yes ;  No
Other Phone:       Unlisted:  Yes ;  No
 
E-Mail: Send E-Mail When Possible;  Yes ; No
  Parish:

MAILING ADDRESS IF DIFFERENT FROM STREET ADDRESS:
 
Mailing Address, Line 1:
Mailing Address, Line 2:
Mailing City / State: Mailing Zip:
PARENT / GUARDIAN REGISTRATION - FOR FAMILY:

PARENT DETAIL:
 
Parent Name:
Last Name: Maiden Name:
First Name: Title:               
Nickname:  Suffix:             
Name Formats Used In Mailings:
  Mailing Name:         
  Informal Salutation:
  Formal Salutation:  

PERSONAL:
 
Relationship:      Type:       
Grade / Degree:  Gender:   
Marital Status:    Birthdate:
Language:         
Ethnicity:           
Religion:           
School:             
Occupation:      
Acknowledgement:  
Location:          

PHONE / E-MAIL:
 
Home Phone:    Unlisted:  Yes ; No
Office Phone:    Unlisted:  Yes ; No
Cell Phone:       Unlisted:  Yes ; No
Other Phone:    Unlisted:  Yes ; No
E-Mail:              Send E-Mail When Possible;  Yes ; No
PARENT / GUARDIAN REGISTRATION - FOR FAMILY:

PARENT DETAIL:
 
Last Name: Maiden Name:
First Name: Title:               
Nickname:  Suffix:             
Name Formats Used In Mailings:
  Mailing Name:         
  Informal Salutation:
  Formal Salutation:  

PERSONAL:
 
Relationship:      Type:       
Grade / Degree:  Gender:   
Marital Status:    Birthdate:
Language:         
Ethnicity:           
Religion:           
School:             
Occupation:      
Acknowledgement:
Location:                

PHONE / E-MAIL:
 
Home Phone:    Unlisted:  Yes ; No
Office Phone:    Unlisted:  Yes ; No
Cell Phone:       Unlisted:  Yes ; No
Other Phone:    Unlisted:  Yes ; No
E-Mail:              Send E-Mail When Possible;  Yes ; No
MEMBER REGISTRATION - FOR FAMILY:

STUDENT DETAIL:
 
Last Name: Maiden Name:
First Name: Title:               
Nickname:  Suffix:            
Name Formats Used In Mailings:
 
Mailing Name:        
Informal Salutation:
Formal Salutation:  

CLASSES:
 
Class: Room: Times:
  Days:  
Class: Room: Times:
  Days:  

PERSONAL:
 
Relatonship:      Type:       
Grade / Degree: Gender:   
Marital Status:   Birthdate:
Language:        
Ethnicity:          
Religion:          
School:            
Occupation:     
Acknowledgement:
Location:                

PHONE / E-MAIL:
 
Home Phone:    Unlisted:  Yes ; No
Office Phone:    Unlisted:  Yes ; No
Cell Phone:       Unlisted:  Yes ; No
Other Phone:    Unlisted:  Yes ; No
E-Mail:              Prefer E-Mail:  Yes ; No

SACRAMENTS:
 
Birthplace: Birth Father:   
  Birth Mother:  
  Mother's Maiden Name:
Baptism: Name Extra Info:
Date: Status:
  Performed by:
  Church Name:
Penance: Name Extra Info:
 
Date: Status:
  Performed by:
  Church Name:
First Communion: Name Extra Info:
 
Date: Status:
Performed by:
Church Name:
Confirmation: Name Extra Info:
 
Date: Status:
  Performed by:
  Church Name:

EMERGENCY CONTACT / BIRTH PARENT INFORMATION:
If the child does not live with both birth parents, also include birth parent information.
 
Name:             
Relationship: Send Courtesy Copies:  Yes ; No
Street Address 1: Street Address 2:
City / State:         Zip:                     
Prefer E-Mail: Yes ; No E-Mail:
Marital Status:    Notes: 
Religion:             
Phones:  
 
Home Phone:    Unlisted:  Yes ; No
Office Phone:    Unlisted:  Yes ; No
Cell Phone:       Unlisted:  Yes ; No
Other Phone:    Unlisted:  Yes ; No
Prefer E-Mail:  Yes ; No E-Mail: 
  Name:           
 
Relationship: Send Courtesy Copies:  Yes ; No
Street Address 1: Street Address 2:
City / State:         Zip:                     
Prefer E-Mail: Yes ; No E-Mail:
Marital Status:    Notes: 
Religion:             
Phones:  
 
 
Home Phone:    Unlisted:  Yes ; No
Office Phone:    Unlisted:  Yes ; No
Cell Phone:       Unlisted:  Yes ; No
Other Phone:    Unlisted:  Yes ; No
Prefer E-Mail:  Yes ; No E-Mail: 
 A message / comments can be submitted in the text box below:

Fee Schedule - - -  2002 - 2003:
  Registration Fee - - K-8

$35/Child

  
  Additional Sacrament Preparation Fees:
  • First Penance/First Communion
  • Confirmation (Including Retreat Fee)


$35/Child
$60/Child

  
 

All fees are due at the time of registration unless other arrangements are made with the office.  If registering on-line using this form, please send your check under separate cover. 

   

Name of person submitting form

Note: Your submission constitutes the equivalent of a signature.
 Note:  Pressing the "Reset Button" clears all information previously entered and it will be necessary to start over.

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Seminole, Fl. 33778
(727) 397-3312
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