St. Barnabas Religious Education Student Enrollment and Family Registration Form 2017 - 2018

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

 *PLEASE PROVIDE ALL INFORMATION BELOW THAT WILL BE CURRENT FOR
 THE 2017-2018 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
*First Name *Last Name
  Middle Name Nickname
*Birth Date
*Gender Female   Male *Grade/Degree
*School
*Religion
Sacraments
*Baptism Received Date Place
   Reconcil Received Date Place
   1st Comm Received Date Place
   Confirm Received Date Place
Student Remarks
  Health Problems
  Other Conditions

*Family Status  New Family Information  Update Existing Family Information
       ID/Env:  

Father or Head of Household
*Title Suffix
*First Name *Last Name
  Middle Name
*Relationship
*Gender Female   Male
*Marital Status
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.
*Cell Phone ( ) - Unlisted
*Work Phone ( ) - Unlisted
  Email 1 Unlisted
Send Email Instead of Mail When Possible

  Mother or Spouse
  Title Suffix
  First Name Last Name
  Middle Name
  Relationship Maiden Name
  Gender Female   Male
Marital Status
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.
  Cell Phone ( ) - Unlisted
  Work Phone ( ) - Unlisted
  Email 1 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.
St. Barnabas