St. Mary Catholic Church
113 S. 6th St. Milbank, SD 57252
605-432-9528 * www.parishonline.com/stmarywilmot
Religious Education Registration
2014 - 2015
Family (Last) Name _____________________
Father’s Name _________________
Are you registered members of St. Lawrence/St. Mary? ⃝ Yes ⃝ No
Mother’s Name __________________
Address _________________________________
Child(ren) live with: ⃝ Mom
⃝ Dad
⃝ Both
⃝ Other
City & Zip ______________________________
Home Phone ____________________ Mom Mobile ____________________ Dad Mobile ____________________
Email* _______________________________________
Mom Catholic? ⃝ Yes ⃝ No
*Only used for communication with the Parish
Dad Catholic? ⃝ Yes ⃝ No
Religious Ed ~ Grades 1-6
Children
Gender
Date of Birth
Grade
Catholic Sacraments Already Received
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Children
Gender
Date of Birth
Grade
Catholic Sacraments Already Received
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________________________________
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Religious Ed ~ Grades 7-12
Are there any medical, learning or behavioral issues we should be aware of? ______________________________________________________
_____________________________________________________________________________________________________________________
In case of emergency, whom should we contact, if parents cannot be reached? Name __________________________
Phone ________________
I agree to allow my child’s picture to be taken during classes and events associated with St. Lawrence/St. Mary and acknowledge that the pictures may be used in print or online for parish
purposes ~ to share with participants or to share with the parish about what’s been happening with the youth or to advertise in the future.
Parent/Guardian Signature ______________________________
FEE - by donation only – to assist in offsetting the expense of textbooks. If you are unable to pay, your child(ren) will still be registered for Religious
Education. Checks may be made out to St. Mary Catholic Church. 1 child = $25, 2 children = $50, 3+ = $75