RC1718

: First Reconciliation/ First Communion Registration

: Candidate Information
Full Name (First, Middle, Last)
Date of Birth:
City and State of Birth:
Street Address:
City:
State:
Home Phone:
School:
Grade:
Date of Baptism:
Church:
Church Address:
: *If baptized at another church, please submit a copy of the Baptism Certificate.
Do you grant permission to Saint Joseph Parish to authorize the release, publication, dissemination, distribution, use, and/or reproduction of any and all photographs taken of my daughter/son during her/his enrollment at Saint Joseph Parish First Reconciliation/First Communion Program by an employee, agent, or representative of Saint Joseph Parish or independent contractor?: YesNo
: Parent/Legal Guardian Information
Father or Guardian Name:
Religion:
Mother/Guardian Name:
Mother's Maiden Name:
Religion:
Parent's Email Address
Registered Members of St. Joseph Parish?
: Medical Information
: Information will be used for Retreat
I hereby give my permission for Saint Joseph Parish Staff or an adult representative of the Saint Joseph Parish First Reconciliation/First Communion program to seek medical attention and treatments deemed necessary for my child/children in the event parents and emergency contacts cannot be reached.: Permission Granted:
YesNo
Emergency Contact Name:
Emergency Contact Phone
Allergies/ Medical Conditions:
: After submitting this form, please submit a registration fee of $30.00 to:
St. Joseph Parish School, 1909 3rd Street, Cuyahoga Falls, Ohio 44221 Attn: 1st Communion
or
St. Joseph Parish, Office of Religious Education, 215 Falls Ave, Cuyahoga Falls, Ohio 44221.

RC1718

First Reconciliation/ First Communion Registration

Candidate Information

Parent/Legal Guardian Information

Medical Information

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