St. Barnabas Religious Education Student Enrollment and Family Registration Form 2018 - 2019

WELCOME TO ST. BARNABAS RELIGIOUS EDUCATION PROGRAM
  Matthew Furjanic - Director of Religious Education

 *PLEASE PROVIDE ALL INFORMATION BELOW THAT WILL BE CURRENT FOR
 THE 2018-2019 SCHOOL YEAR*
 
 Additional students can be entered at the bottom of the form by clicking "Add Another
 Student"
Click Submit Form to send this information to St. Barnabas.
*Required fields
Student 1 Type
  Title Suffix
*First Name *Last Name
  Middle Name Nickname
  Relationship Maiden Name
  Ethnicity Birth Date
*Gender Female   Male Grade
  Language Marital Status
  School
  Religion
Phone Note: If you would like to receive a text message when your parish sends a quick communication, select your provider from the Description drop-down list. Standard text messaging rates apply.
  Phone 1 ( ) - Unlisted
  Phone 2 ( ) - Unlisted
  Email 1 Unlisted
Send Email Instead of Mail When Possible
  Email 2 Unlisted
Send Email Instead of Mail When Possible
Sacraments
   Baptism Date Place
   Reconcil Date Place
   1st Comm Date Place
   Confirm Date Place
Student Remarks
  General Remarks
  Health Problems
  Other Conditions

*Family Options  New Family  Update Existing Family
        - ID/Env  

Parent 1
  Title Suffix
*First Name *Last Name
  Middle Name Nickname
  Relationship Maiden Name
  Ethnicity Birth Date
*Gender Female   Male Grade/Degree
  Language Marital Status
  School
Phone Note: If you would like to receive a text message when your parish sends a quick communication, select your provider from the Description drop-down list. Standard text messaging rates apply.
  Phone 1 ( ) - Unlisted
  Phone 2 ( ) - Unlisted
  Email 1 Unlisted
Send Email Instead of Mail When Possible
  Email 2 Unlisted
Send Email Instead of Mail When Possible

  Parent 2
  Title Suffix
  First Name Last Name
  Middle Name Nickname
  Relationship Maiden Name
  Ethnicity Birth Date
  Gender Female   Male Grade/Degree
  Language Marital Status
  School
Phone Note: If you would like to receive a text message when your parish sends a quick communication, select your provider from the Description drop-down list. Standard text messaging rates apply.
  Phone 1 ( ) - Unlisted
  Phone 2 ( ) - Unlisted
  Email 1 Unlisted
Send Email Instead of Mail When Possible
  Email 2 Unlisted
Send Email Instead of Mail When Possible

Family Street Address
*Line 1
  Line 2
*City
*State
*ZIP
  Parish

Family Phone Numbers
Note: If you would like to receive a text message when your parish sends a quick communication, select your provider from the Description drop-down list. Standard text messaging rates apply.
*Primary ( ) - Unlisted
  Other ( ) - Unlisted
Family Email Address
*Email Unlisted
Send Email Instead of Mail When Possible


Click Submit Form to send this information to St. Barnabas.
 ↻ 

*Enter the characters shown in the image


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