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  • Student Name REQUIRED Please fill out this field. Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY 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 Please fill out this field. Please enter a phone number.
  • Birth date REQUIRED Please fill out this field. Please enter a date.
  • Date of Chrismation REQUIRED Please fill out this field. Please enter a date.
  • Date of Baptism REQUIRED Please fill out this field. Please enter a date.
  • First Confession REQUIRED (Select One) YES NO Please fill out this field.
  • Please list Parishes where sacraments were received.
  • Baptism: Parish name with city and state. Please enter valid data.
  • Chrismation: Parish name with city and state. Please enter valid data.
  • First Confession: Parish name with city and state. Please enter valid data.
  • Grade REQUIRED (Select One) Kindergarten 1st Grade 2d grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Other Please fill out this field.
  • I agree to have my child attend at least 20 of the weekly classes during this school year. 
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  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Date REQUIRED Please fill out this field. Please enter a date.
  • St. Mary's Religious Ed 

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