Form A - for New Students / para los Nuevos Estudiantes - St. Therese of Lisieux

Father Name/ Padre Nombre: REQUIRED Please fill out this field. Please enter valid data.

Father Tel/Cell Phone/ Padre Telefono: Please enter a phone number.

Cell phone Providor/Proveedor de Celular (Verizon, Sprint, AT&T….): REQUIRED Please fill out this field. Please enter valid data.

Mother Name/ Madre Nombre: REQUIRED Please fill out this field. Please enter valid data.

Mother Tel/Cell Phone/ Madre Telefono: Please enter a phone number.

Cell phone Providor/ Proveedor de Celular (Verizon, Sprint, AT&T….): REQUIRED Please fill out this field. Please enter valid data.

Street Address/ Dirección REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email Please enter an email address.

Date Registered/ Fecha de Registro REQUIRED Please fill out this field. Please enter a date.

Does your child/children have any medical requirements the teacher should be aware?/ Tiene su niño alguna enfermedad que la professor deba saber? REQUIRED Please fill out this field.

Name of Emergency Contact Person / Nombre REQUIRED Please fill out this field. Please enter valid data.

Relationship/ Relacion REQUIRED Please fill out this field. Please enter valid data.

Emergency Tel/Cell Phone/ EmergencyTelefono: REQUIRED Please fill out this field. Please enter a phone number.

Cell phone Providor/Proveedor de Celular (Verizon, Sprint, AT&T….): REQUIRED Please fill out this field. Please enter valid data.

The following question asks how many students you are enrolling. It will give you the number of forms for each child to fill out individually /
La siguiente pregunta se refiere a cuántos estudiantes está inscribiendo . Le dará la cantidad de formularios para que cada niño complete individualmente

Students / Estudiantes REQUIRED Please fill out this field.
Student 1
- Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
- Grade / Grado REQUIRED Please fill out this field.
- Gender / Sexo REQUIRED Please fill out this field.
- School / Escuela REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
- Answer Yes or No for each Sacrament (IF YES, SUBMIT CERTIFICATES WITHIN 2 WEEKS)
- BAPTISM / BAUTIZO REQUIRED Please fill out this field.
- RECONCILIATION / RECONCILIACIÓN REQUIRED Please fill out this field.
- 1ST COMMUNION / PRIMERA COMUNIÓN REQUIRED Please fill out this field.
- CONFIRMATION / CONFIRMACIÓN REQUIRED Please fill out this field.
- Other
- How would you like your child to attend class?/ ¿Cómo le gustaría que su hijo asista a clase? REQUIRED In person at church?/en la Iglesia Online class from home?/desde casa Please fill out this field.
- Hobbies / Pasatiempos REQUIRED Please fill out this field. Please enter valid data.
Student 3
- Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
- Grade / Grado REQUIRED Please fill out this field.
- Gender / Sexo REQUIRED Please fill out this field.
- School / Escuela REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
- Answer Yes or No for each Sacrament (IF YES, SUBMIT CERTIFICATES WITHIN 2 WEEKS)
- BAPTISM / BAUTIZO REQUIRED Please fill out this field.
- RECONCILIATION / RECONCILIACIÓN REQUIRED Please fill out this field.
- 1ST COMMUNION / PRIMERA COMUNIÓN REQUIRED Please fill out this field.
- CONFIRMATION / CONFIRMACIÓN REQUIRED Please fill out this field.
- Other
- How would you like your child to attend class?/ ¿Cómo le gustaría que su hijo asista a clase? REQUIRED In person at church?/en la Iglesia Online class from home?/desde casa Please fill out this field.
- Hobbies / Pasatiempos REQUIRED Please fill out this field. Please enter valid data.
Student 4
- Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
- Grade / Grado REQUIRED Please fill out this field.
- Gender / Sexo REQUIRED Please fill out this field.
- School / Escuela REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
- Answer Yes or No for each Sacrament (IF YES, SUBMIT CERTIFICATES WITHIN 2 WEEKS)
- BAPTISM / BAUTIZO REQUIRED Please fill out this field.
- RECONCILIATION / RECONCILIACIÓN REQUIRED Please fill out this field.
- 1ST COMMUNION / PRIMERA COMUNIÓN REQUIRED Please fill out this field.
- CONFIRMATION / CONFIRMACIÓN REQUIRED Please fill out this field.
- Other
- How would you like your child to attend class?/ ¿Cómo le gustaría que su hijo asista a clase? REQUIRED In person at church?/en la Iglesia Online class from home?/desde casa Please fill out this field.
- Hobbies / Pasatiempos REQUIRED Please fill out this field. Please enter valid data.
Student 5
- Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
- Grade / Grado REQUIRED Please fill out this field.
- Gender / Sexo REQUIRED Please fill out this field.
- School / Escuela REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
- Answer Yes or No for each Sacrament (IF YES, SUBMIT CERTIFICATES WITHIN 2 WEEKS)
- BAPTISM / BAUTIZO REQUIRED Please fill out this field.
- RECONCILIATION / RECONCILIACIÓN REQUIRED Please fill out this field.
- 1ST COMMUNION / PRIMERA COMUNIÓN REQUIRED Please fill out this field.
- CONFIRMATION / CONFIRMACIÓN REQUIRED Please fill out this field.
- Other
- How would you like your child to attend class?/ ¿Cómo le gustaría que su hijo asista a clase? REQUIRED In person at church?/en la Iglesia Online class from home?/desde casa Please fill out this field.
- Hobbies / Pasatiempos REQUIRED Please fill out this field. Please enter valid data.
Student 6
- Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
- Grade / Grado REQUIRED Please fill out this field.
- Gender / Sexo REQUIRED Please fill out this field.
- School / Escuela REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
- Answer Yes or No for each Sacrament (IF YES, SUBMIT CERTIFICATES WITHIN 2 WEEKS)
- BAPTISM / BAUTIZO REQUIRED Please fill out this field.
- RECONCILIATION / RECONCILIACIÓN REQUIRED Please fill out this field.
- 1ST COMMUNION / PRIMERA COMUNIÓN REQUIRED Please fill out this field.
- CONFIRMATION / CONFIRMACIÓN REQUIRED Please fill out this field.
- Other
- How would you like your child to attend class?/ ¿Cómo le gustaría que su hijo asista a clase? REQUIRED In person at church?/en la Iglesia Online class from home?/desde casa Please fill out this field.
- Hobbies / Pasatiempos REQUIRED Please fill out this field. Please enter valid data.
Student 2
- Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
- Grade / Grado REQUIRED Please fill out this field.
- Gender / Sexo REQUIRED Please fill out this field.
- School / Escuela REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
- Answer Yes or No for each Sacrament (IF YES, SUBMIT CERTIFICATES WITHIN 2 WEEKS)
- BAPTISM / BAUTIZO REQUIRED Please fill out this field.
- RECONCILIATION / RECONCILIACIÓN REQUIRED Please fill out this field.
- 1ST COMMUNION / PRIMERA COMUNIÓN REQUIRED Please fill out this field.
- CONFIRMATION / CONFIRMACIÓN REQUIRED Please fill out this field.
- Other
- How would you like your child to attend class?/ ¿Cómo le gustaría que su hijo asista a clase? REQUIRED In person at church?/en la Iglesia Online class from home?/desde casa Please fill out this field.
- Hobbies / Pasatiempos REQUIRED Please fill out this field. Please enter valid data.

Please click on the following documents to read / Por favor, haga clic en los siguientes documentos para que diga:

Protecting God's Children
( PRINT and RETURN SLIP to Religious Education office if you DON'T PERMIT your child/children to attend this class / IMPRIMIR y DEVOLVER LA COPIA a la oficina de Educación Religiosa si NO PERMITE que su hijo(s) asista a esta clase)

Medical, Audio & Video Waiver

Re: Commitment of Support / Compromiso de Apoyo

I, together with my family, commit to support our child/children in faith formation in ways such as:
Yo, junto con mi familia, nos comprometemos a apoyar a nuestro(s) niño(s) en su formación de fe de formas tales como:

Going to Mass every Sunday
Ir a misa todos los domingos
Attending workshops / sessions / meetings
Asistir a talleres / sesiones / reuniones
Praying together and doing other acts of Christian faith at home
Orando juntos y haciendo otros actos de fe cristiana en casa

I have read all and I Agree / Leo todo y estoy de acuerdo Please select this field.

Print signature of parent/guardian / Imprimir firma del padre / tutor REQUIRED Please fill out this field. Please enter valid data.

Are you registered as member(s) of this parish? / Esta usted inscrito como miembro de esta parroquia? REQUIRED Please fill out this field.

If Yes, What last name? / Conque apellido Please enter valid data.

If you are NOT registered, please also FILL OUT the PARISH REGISTRATION FORM / Si NO está registrado, también LLENE el FORMULARIO de REGISTRO PARROQUIAL

T o make payment of registration fee of $20/ child or a maximum of $60/ family:

Click on the icon to open a new window
Choose to pay for Faith Formation Class (under Events and Collections)
Make your payment
Click back to the Form A window
Submit your completed form

St. Thérèse of Lisieux

Catholic Church

Form A - for New Students / para los Nuevos Estudiantes

Form A - New Student