Christian Formation Online Registration Family Name*Primary Family e-mail* Father’s Full Name* First Last Virtus Trained*YesNoMother’s Full Name* First Last Virtus Trained*YesNoMother’s Maiden Name* Last Address* Street Address City State ZIP Code Home Phone*Cell Phone*Student InformationStudent’s Full Name* First Last Full Date of Birth* MM DD YYYY Gender*MaleFemaleAge*School 2014/2015*Entering Grade*Sacramental HistoryGive date, church, city and state for each sacrament received.Baptism1st EucharistConfirmationDid this child attend a Catholic Religious Education Program last year?*YesNoWhereList any allergies, health concerns or special needs that would give our catechists the appropriate support to teach your child:*Photo ReleaseI give permission for pictures and / or video of my child (named above) engaged in activities related to the Parish or Diocesan events to be posted in St Nicholas Catholic Church publication, websites or other social media.*YesNoParent / Guardian Signature*Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920