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Communion Program Registration

- Register for Communion I and II
  
  Welcome to our Registration page for Communion Program. Please note that you must fill in all boxes to complete registration.
  
  You must provide the Parish office with copies of
  1. Birth Certificate of your Child
  2. Baptismal Certificate
  
  If your child has not yet been Baptized, Please contact our Religious Education Office for the requirements for Baptism for children ages 7-18. Phone: 818-893-3152
- This form is not accepting responses at this time.
  
  Registration for Communion Program:
  
  Please Select One: REQUIRED Please fill out this field.
  
  Student Information:
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Date of Birth Please enter valid data.
  
  Date of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Elementary School REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Parent Information:
  Mother
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent Information:
  Father
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  I understand and agree that I must submit a copy of my child's birth certificate and Baptismal Certificate before the start of classes.
  Certificates can be brought into the Parish office or emailed to RChan@stgenchurch.org
  
  I Agree Please select this field.
  
  Registration125.0
  
  Total:
  
  Submit
  
  Proceed to Payment