Register 3 or more children

Is your family new to St. Ignatius? Select all that apply Yes No

Family Last Name *

Address (Street, Town, Zip) *

Is this a new address? Select all that apply Yes No

email *

Parish Envelope #

Language Spoken at Home *

Has there been a change to the parental information? Select all that apply Yes No

Father/Guardian's Name (Last, First) *

Father's Home Phone *

Father's Office Phone

Father's Cell Phone

Father's Marital Status (choose 1) Select all that apply Married Divorced Separated Widowed Single

Mother/Guardian's Name (Last, First) *

Mother's Maiden Name

Mother's Home Phone *

Mother's Office Phone

Mother's Cell Phone

Mother's Marital Status (choose 1) Select all that apply Married Divorced Separated Widowed Single

Child 1 Name

Child 1 Date of Birth

Child 1 Sex Select all that apply Male Female

Child 1 School Attending

Child 1 Religious Ed Grade

Child 2 Name

Child 2 Date of Birth

Child 2 Sex Select all that apply Male Female

Child 2 School Attending

Child 2 Religious Ed Grade

Child 3 Name

Child 3 Date of Birth

Child 3 Sex Select all that apply Male Female

Child 3 School Attending

Child 3 Religious Ed Grade

If new to the program, is your child(ren) baptized? If yes, when?

If new to the program, has your child(ren) received communion? If yes, when?

Please list any special circumstances that could be helpful to us (allergies, special education, custody, restraining orders...)

Emergency local contacts in case parents/guardians can't be reached (Name, Address, Phone)

If registering more than 3 children, how many ADDITIONAL children are you registering? (choose 1) Select all that apply 1 additional child (+ $30.00) 2 additional children (+ $60.00) 3 additional children (+ $90.00) 4 additional children (+ $120.00)

Register 3 or more children

If you are registering more than 3 children, fill out this form below for each additional child and click <Submit>

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