Family Registration Form

Welcome to the Idaho Falls Catholic Community Religious Education program. Please complete the form and submit. Payment is due on the first day of class.

When you submit this form, all of the information will be sent by e-mail to Holy Rosary Religious Education.

* Required fields

Student-* Type

Title

*First Name

*Last Name

Suffix

Birth Date:

Gender: Female Male

Sacraments	Rcv	Date
Baptism
1ST COMM
Reconcil
Confirm

Please specify if your child has attended Sacramental Preparation classes before. If so where and when.

Registration Fee $ 30.00
1st Class Choice
Alternate Choice

Additional Information (Special Circumstances, medication, allergies...)

* Required fields
Head of Household
Title	* First Name	* Last Name	Suffix

Birth Date:		* Gender: Female Male
Spouse
Title	First Name	Last Name	Suffix

Birth Date:		Gender: Female Male
Address
* Line 1
Line 2
* City
* State
* ZIP
E-Mail
	Send E-Mail Instead of Mail When Possible
Phone
* Primary	( ) - Unlisted
Other	( ) - Unlisted

Emergency Contact Information

Title

First Name

Last Name

Suffix

Relationship

Address for Emergency Contact

Line 1

City

State

Zip -

Email use Email

Phone for Emergency Contact

Primary Phone

()

Unlisted

Other Phone

()

Unlisted

When you submit this form, all of the information will be sent by e-mail to Holy Rosary Religious Education.