St. Raymond & St. Leo the Great Catholic Church

Date*

Student's Name*

Grade*

Registration Fee

Student's Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Date of Birth*

City of Birth*

Date of Baptism

Church

Date of First Communion

First Communion Church

Name of School*

Mother's Name

Her Religion

Father's Name

His Religion

Child Lives with:*

Both Parents

Mother

Father

Other

Home Phone*

Cell Phone*

Email*

Emergency Contact, if other than parent: Name

Phone

Relationship to Child

Siblings*

Yes

No

Siblings Names & Grade Levels

Is family registered in Parish?*

Yes

No

If yes, please enter Envelop Number

CCD Registration