EPIPHANY OF THE LORD CATHOLIC CHURCH
RELIGIOUS EDUCATION PROGRAM (Print
Form in Landscape format)
3 Yr. Old Thru 12th Grade
Middle School and High School
Class Time: Wednesday 7:00-8:00 p.m
Classes begin: Sept. 8, 2010.
3 yr. To 5th Grade: Sunday 9:00 a.m. or 11:15 a.m. (Please circle
one.)
Classes begin: Sept. 12, 2010
Must be 3 by September 1, 2010
PARENTS LAST NAME____________________________ FATHER_____________________________ CATHOLIC-YES/NO (PLEASE CIRCLE)
MOTHER____________________________ CATHOLIC-YES/NO (PLEASE CIRCLE)
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IF YOU HAVE A PREFERENCE FOR CLASS PLACEMENT,
STREET ADDRESS
CITY
ZIP CODE
PLEASE SPECIFY AT TIME OF ENROLLMENT.
_______________________
________________________
_____________________________
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HOME PHONE
FATHER WORK
FATHER CELLULAR
_______________________
__________________________
_____________________________
E-Mail Address ________________________________
HOSPITAL PREFERENCE
MOTHER WORK
MOTHER CELLULAR
PLEASE CHECK EACH SACRAMENT RECEIVED
STUDENT NAME B
IRTH DATE GRADE BAPTISM 1ST 1ST CONF.TUITION: $25-PER
CHILD
$50-PER FAMILY
$15-ADDITONAL SACRAMENTAL FEE
___________ CHECKS ONLY-----NO CASH PLEASE!
AMOUNT PD.
Please return completed forms to the R.E. Office, 722-0051.
ALL THREE PAGES MUST BE COMPLETED FOR ENROLLMENT. (Enrollment & On-Site
Consent Forms)