Our Lady Queen of Peace Parish
Religious Education/Confirmation Program 2015-2016
Registration Form
DATE_____________________
CHILD’S NAME ___________________________________________
BIRTHDATE_______________________________________
FATHER_______________________________
AGE ___________
MOTHER_______________________________________
ADDRESS________________________________________________________________________________
Street
City
Zip
PHONE________________________________ E-mail____________________________________________
Date of Baptism___________________ CHURCH/CITY___________________________________________
Date of Reconciliation______________ CHURCH/CITY___________________________________________
Date of First Eucharist______________ CHURCH/CITY___________________________________________
Previous Religious Education (Parish, City, Grades)________________________________________________
________________________________________________________________________
Present School______________________________________________________________Grade___________
Other children in family:
______________________________Age_______
______________________________Age_______
______________________________Age_______
Parent’s Signature____________________________ Email Address_________________________________
FOR OFFICE USE ONLY
REGISTRATION FEE (Parish Member) 1 child $ 90.00 per child
2 children $ 150.00 per family
3 or more $ 185.00 per family
SACRAMENT FEE: $35.00 per child
CONFIRMATION REGISTRATION FEE: $90.00
Retreat Fee: $65.00
NON-PARISH MEMBER FEE: $175.00 per child plus fees (sacrament/retreat) if applicable
Amount Paid______________________ Date______________ Initial____________
Check# ____________
Cash_____