GALLUP RELIGIOUS EDUCATION REGISTRATION
Any changes to this form? Yes/No Year
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Students’ Name: ______________________________ Phone ____________
Address:____________________________________________________________________________
Birth Date: _________________
Work/Cell Phone: Mother:_______________________________ Father:__________________________________
Email: Mother:___________________________________________ Father:________________________________
Emergency Contact Person __________________________________ Phone: __________
Father: __________________________________ Religion____________________________
Baptized? Yes / No Church:______________________________ City/State ________________________
First Communion? Yes / No Confirmation? Yes / No
Mother: ________________________________ Religion____________
Baptized? Yes / No
Church: _____________________________ City/State __________________________
First Communion Yes / No Confirmation Yes / No
Are father & mother married in the Roman Catholic Church? Yes / No
If not, may we help you receive the Sacrament of Matrimony? Yes / No
If divorced, separated or annulled, who has custody of the children?_____________________________________________
Who is allowed to pick up your child _______________________________________________________
Child’s Grade in school year: 2020–2021___ 2021-2022____
2022–2023___ 2023-2024___
DATE CHURCH CITY & STATE COPY PROVIDED
Baptism _________ _________________ _______________________ _____
1st Penance _________ _________________ _______________________ _____
1st Eucharist _________ _________________ _______________________ _____
Confirmation _________ _________________ _______________________ _____
*Any allergies or special classroom needs? ___________________________________________________________________
**FOR NEW STUDENTS. PLEASE PROVIDE A COPY OF YOUR BAPTISMAL CERTIFICATE WHEN REGISTERING.**Please return this form to the parish office, please call if you have any questions (505)722-6644