Our Lady of Hope Religious Education Program
61-21 71 Street
Karen Colletti
Middle Village, N.Y. 11379
Director
(718) 335-8394
E-Mail ajcdon23@aol.com
www.ourladyofhopeparish.org
2015/2016 Registration Form
Please fill out the form and return it in the envelope. Fee is payable to Our Lady of Hope CCD.
FEE: $125 for ONE child $150 for TWO OR MORE CHILDREN.
*** IF YOU HAVE A NEW CHILD REGISTERING, PLEASE INCLUDE A COPY OF THEIR
BAPTISMAL CERTIFICATE EVEN IF THEY ARE BAPTISED AT HOPE***
Name of Child/Children
Public School
Grade in Sept.
***Special Needs
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Address ______________________________
Home Phone # ______________________
Town & Zip ____________________________
E-mail ___________________________
Mother=s Maiden Name ______________________________ Cell
phone__________________
Father=s Name ____________________________________ Cell
phone__________________
Emergency contact if you are not available:
Name ___________________________
Phone # _________________________
Parent=s Signature ___________________________________________________
** Special help your child may need:
*** My child/children WILL NOT be returning to Our Lady of Hope Rel. Ed. Program:***
__________________________________________________________________