Christian Formation Online Registration

Family Name*
Primary Family e-mail*
Father’s Full Name*
First Last
Virtus Trained*
- Yes
- No
Mother’s Full Name*
First Last
Mother’s Maiden Name*
Last
Virtus Trained
Address*
Street Address City State ZIP Code
Home Phone*
Cell Phone*
Student Information
Student’s Full Name*
First Last
Full Date of Birth*
MM
DD
YYYY
Gender*
- Male
- Female
Sacramental History
Give date, church, city and state for each sacrament received.
Baptism
1st Eucharist
Confirmation
Did this child attend a Catholic Religious Education Program last year?*
- Yes
- No
If yes, where?
List any allergies, health concerns or special needs that would give our catechists the appropriate support to teach your child:*
Photo Release
I 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.*
- Yes
- No
Parent / Guardian Signature*
Date*

Student Information