Home
Clergy & Staff
The Lourdian
How Do I Become a Member?
New Parishioner
Update Info
History
Contact Us
Liturgy
Mass Times
Confession Times
Sacraments
Baptism
Reconciliation
Holy Eucharist
Confirmation
Becoming Catholic (RCIA)
Holy Matrimony
Holy Orders
Adult Confirmation
Anointing of the Sick
Ministries
Ministry Sign-Up
Ministry Schedule
Flocknote Enrollment
Christian Mothers
Knights of Columbus
Parish Council
Prayer Requests
Mass Intentions
Faith Formation
Youth Religious Education
Register for Classes
Marriage and Family Life
Child & Youth Protection
Catechist Resources
Faith Resources
Prayer Activities
News & Events
Eucharistic Revival
Scrip Program
Calendar
Vatican News
Media
Devotions
Videos
Our Diocese
|||
Mass Times
Contact Us
Facebook
Instagram
Flocknote
Search
Search
Home
Clergy & Staff
The Lourdian
How Do I Become a Member?
History
Contact Us
Liturgy
Mass Times
Confession Times
Sacraments
Baptism
Reconciliation
Holy Eucharist
Confirmation
Becoming Catholic (RCIA)
Holy Matrimony
Holy Orders
Adult Confirmation
Anointing of the Sick
Ministries
Ministry Sign-Up
Ministry Schedule
Flocknote Enrollment
Christian Mothers
Knights of Columbus
Parish Council
Prayer Requests
Mass Intentions
Faith Formation
Youth Religious Education
Marriage and Family Life
Child & Youth Protection
Catechist Resources
Faith Resources
Prayer Activities
News & Events
Eucharistic Revival
Scrip Program
Calendar
Vatican News
Media
Devotions
Videos
Our Diocese
Youth Religious Education Registration
Faith Formation
Youth Religious Education
Register for Classes
Marriage and Family Life
Child & Youth Protection
Catechist Resources
Faith Resources
Prayer Activities
2022-2023 Our Lady of Lourdes Youth Religious Education Registration
The maximum number of form submissions has been reached. This form is currently not available.
Parent/Guardian Email Address
REQUIRED
Please fill out this field.
Please enter valid data.
First Name of Student
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name of Student
REQUIRED
Please fill out this field.
Please enter valid data.
Student Date of Birth
REQUIRED
Please fill out this field.
Please enter valid data.
Student's School Grade as of September 2022
REQUIRED
(Select One)
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
Please fill out this field.
Last Grade Student Completed in Religious Education
REQUIRED
(Select One)
None
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
Please fill out this field.
Name of Parish Where Completed:
REQUIRED
Please fill out this field.
Please enter valid data.
Name of Church where student was Baptized:
REQUIRED
Please fill out this field.
Please enter valid data.
Baptism Year:
REQUIRED
Please fill out this field.
Please enter valid data.
Name of Church where student received First Communion:
REQUIRED
Please fill out this field.
Please enter valid data.
First Communion Year:
REQUIRED
Please fill out this field.
Please enter valid data.
Is the student preparing for First Communion? If so, what year of preparation are they in:
REQUIRED
(Select One)
No
Year 1
Year 2
Year 3
Please fill out this field.
Is the student preparing for Confirmation? if so, what year of preparation are they in:
REQUIRED
(Select One)
No
Year 1
Year 2
Year 3
Please fill out this field.
Is the student interested in joining the following Youth Ministry Programs?
REQUIRED
Altar Serving
Reading at Mass as a Lector or Commentator
Youth Ushers
Youth Choir
None
Please fill out this field.
Is your family registered at Our Lady of Lourdes Church?
REQUIRED
Yes
No
Please fill out this field.
Name of Parent / Guardian (Last Name, First Name)
REQUIRED
Please fill out this field.
Please enter valid data.
Home 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.
Please enter valid data.
Zip Code
Please enter valid data.
Primary Phone Number
REQUIRED
Please fill out this field.
Please enter valid data.
Secondary Phone Number
Please enter valid data.
Does student have any allergies or health issues?
REQUIRED
Yes
No
Please fill out this field.
If so, please provide details below:
Does the Student carry an Epi Pen?
REQUIRED
Yes
No
Please fill out this field.
Does the Student have an IEP (Individualized Education Plan)?
REQUIRED
Yes
No
Please fill out this field.
If so, please provide details below:
Any Special needs or relevant information that you would like us to know?
Dietary Restrictions?
REQUIRED
(Select One)
None
Vegetarian
Vegan
Kosher
Gluten-free
Dairy
Please fill out this field.
Emergency Contact ( Last Name, First Name)
REQUIRED
Please fill out this field.
Please enter valid data.
Relationship to Student:
REQUIRED
Please fill out this field.
Please enter valid data.
Emergency Contact Phone Number
REQUIRED
Please fill out this field.
Please enter valid data.
Who is allowed to pick up Student: (Please provide full name and contact phone numbers)
REQUIRED
Please fill out this field.
Electronic Signature (Last Name, First Name)
REQUIRED
Please fill out this field.
Please enter valid data.
Date of Registration
REQUIRED
Please fill out this field.
Please enter valid data.
I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document
REQUIRED
I hereby grant permission to the student I am registering to participate in Religious Education this year.
Please fill out this field.
Submit
This site is protected by reCAPTCHA and the Google
Privacy Policy
and
Terms of Service
apply.