EPIPHANY OF THE LORD CATHOLIC CHURCH RELIGIOUS EDUCATION PROGRAM  (Print Form in Landscape format)
3 Yr. Old Thru 12th Grade

Session begins September 2008
Middle School and High School Class Time:   Wednesday 7:00-8:00 p.m.
3 yr. To 5th Grade:  Sunday 9:00 a.m. or 11:15 a.m. (Please circle one.)               Must be 3 by September 1, 2008

PARENTS LAST NAME____________________________ FATHER_____________________________                     CATHOLIC-YES/NO (PLEASE CIRCLE)

                                                                                             MOTHER____________________________                       CATHOLIC-YES/NO (PLEASE CIRCLE)

______________________________________________________________________________________                                IF YOU HAVE A PREFERENCE FOR CLASS PLACEMENT,
STREET ADDRESS                                                CITY                                         ZIP CODE                                                            PLEASE SPECIFY AT TIME OF ENROLLMENT.

_______________________        ________________________                    _____________________________                       ____________________________________________
HOME PHONE                               FATHER WORK                                           FATHER CELLULAR

_______________________         __________________________               _____________________________                      E-Mail Address ________________________________
HOSPITAL PREFERENCE              MOTHER WORK                                        MOTHER CELLULAR

PLEASE CHECK EACH SACRAMENT RECEIVED

STUDENT NAME                                                                   BIRTH DATE                     GRADE                      BAPTISM                       1ST                                1ST                           CONF.
LIST LAST NAME IF DIFFERENT                                                                                                                                                        RECON.                         COMM.

             
             
             
             
             

TUITION:           $25-PER CHILD                 $50-PER FAMILY                           $15-ADDITONAL SACRAMENTAL FEE
___________ PLEASE ATTACH CHECK
AMOUNT PD.
Please return completed forms to Roxann Lackner, R.E. Office, 722-0051

ALL THREE PAGES MUST BE COMPLETED FOR ENROLLMENT. (Enrollment & On-Site Consent Forms)

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