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Catechesis of the Good Shepherd School
Please register in the Parish before submitting this form.
Family Last Name As Registered in the Parish
*
Father's Name
*
Mother's Name
*
Mother's Maiden Name
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
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District of Columbia
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
Please complete the following for each child entering the St. Nicholas PSR Program.
A copy of his/her baptismal certificate must accompany this registration form to be enrolled in a class. Registration in the parish is a prerequisite.
1. Child's Name
First
Middle
Last
M/F
Male
Female
Date of Birth
Date Format: MM slash DD slash YYYY
Grade in School
Name of School
2. Child's Name
First
Middle
Last
M/F
Male
Female
Date of Birth
Date Format: MM slash DD slash YYYY
Grade in School
Name of School
3. Child's Name
First
Middle
Last
M/F
Male
Female
Date of Birth
Date Format: MM slash DD slash YYYY
Grade in School
Name of School
Do any of your children have allergies, an IEP or 504, other? If yes, please explain:
Emergency Contact Name
First
Last
Emergency Contact Phone Number