Note

Please forward this completed form with a $15.00 book and materials fee enclosed by

October 28, 2016

First Penance Registration Form

Candidate Information:

First Name: (required)

Middle Name: (required)

Last Name: (required)

Birth date(*): (required)

Grade: (required)

Age: (required)

Street Address: (required)

City: (required)

State: (required)

Zip Code: (required)

Parent's Email: (required)

Parent's Telephone: (required)

Father's Information:

First Name:

Middle Name:

Last Name:

Mother's Information:

First Name:

Middle Name:

Last Name:

Maiden Name:

General Information:

Which church site does your child attend?

(A copy of the Baptismal Certificate must to be provided if baptized outside of Blessed Trinity/St. Patrick Parishes)

Baptism date(*): (required)

Place of Baptism:

Church Name: (required)

Street Address: (required)

City: (required)

State: (required)

Zip Code: (required)

I give permission for non-tagged (name not included) pictures of my child to be used for informational purposes only. This may include the parish website, newspapers, Parish Facebook, or parish pictures directories. (required)

Additional Comments?

(*) Depending on your browser, the date can be accepted in many ways. Below are a few examples.

Microsoft Internet Explorer: (YYYY-MM-DD)
2016-01-05

Microsoft Edge with Windows 10: (has the ability to click and select a date, but uses MM-DD-YYYY)

Google Chrome: (has the ability to click and select a date, but uses MM-DD-YYYY)

If problems persist, please email the webmaster (email at the bottom of this page) with the browser you are using.