Membership Application Form s13

Religious Education Registration Information

St. James Catholic Church

2016 – 2017

Please include all information. Even though you may have filled out a registration form last year it is important for us to verify information and ensure that we have the most up-to-date information.

Cost of registration: $25 per student; $40 maximum per family.

Religious Education Registration

Parent Information

Family Name:
Mother: / Father: / Email:
Current address:
City: / State: / Zip Code:
Home Phone: / Cell Phone: / Alt. Cell:

Preferred Method of Contact:

Student Information

Name of Student
Grade in 2016-2017: / Date of Birth:
Name of Student
Grade in 2016-2017: / Date of Birth:
Name of Student
Grade in 2016-2017: / Date of Birth:
Name of Student
Grade in 2016-2017: / Date of Birth:

Emergency Contact

Name of Contact:
Address: / Phone:
City: / State: / Zip Code:
Relationship:

Medical Concerns/ ALLergies:

Allergies:
Medical Issues/Medications: