OUR LADY OF GUADALUPE HELOTES, TEXAS
Application for the Sacraments of lst Eucharist/lst Reconciliation
Grade 3rd – 5th
PLEASE PRINT NAME CLEARLY
Today’s Date: __________
Candidate’s Name:
Last Name
First Name (LEGAL)
Middle Name
Candidate’s nickname:_______________________
Candidate’s Grade:
Candidate’s Age: _________
Candidate’s Gender: Male or Female
(Circle one)
Family Last Name:
Father’s Name on birth certificate
First (Legal)
Mother’s Name:
First (Legal)
Middle
Maiden Name:
Middle
Name of Person(s) legally responsible for this Child_________________________________________________________
PLEASE PRINT CLEARLY
Address:
City
State
Zip ___________
Home # :
Mother’s Cell:
Father’s Cell:
Email Address:
Candidate’s Date of Birth:
__Candidate’s Place of Birth:
Candidate’s Church of Baptism:
__Candidate’s Date of Baptism:
Candidate’ City of Baptism: _________________________________
City
_________
State
Staple a copy of your child’s baptism certificate to this application
FOR OFFICE USE ONLY
Parish soft ID # _______________
Copy of Baptismal Certificate
Fees_________
Books Received__________
Day Retreat _______
Reconciliation Date _______________
Communion Register: Vol _______ Pg ______ #_______
Communion Certificate _________
Eucharist Date entered into Data System_____________
Re Requirement fulfilled: _________________________
Notes:
Date of 1st Eucharist Mass _____________________
SACRAMENT PERFORMED BY: ___________________________________________________________________