Family Last Name*Cell Phone Number*Home PhoneAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Contact Email Address* Enter Email Confirm Email Father's Last Name*Father's First Name*Father's Religion*Mother's Last Name*Mother's First Name*Mother's Religion*Marital Status* Single Married Separated Divorced Widowed STUDENT INFORMATIONHow many children will you be registering?*Please enter a number from 1 to 4.1st CHILDFirst Name*Middle NameLast Name*Grade* Pre-K Kindergarten Grade 1 First Communion Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Confirmation 1st Child – School of AttendanceAge*Date of Birth* MM slash DD slash YYYY Place of Birth*Sacraments Received* None Baptism First Communion If 1st Child is Baptized, Enter NAME & PLACE of Church*If 1st Child Has Had First Holy Communion, Enter NAME & PLACE of Church*Is this child taking any type of medication?* No Yes If "Yes" please describe*Is this child allergic to any medication?* No Yes If "Yes" please describe*2nd CHILDFirst Name*Middle NameLast Name*Grade* Pre-K Kindergarten Grade 1 First Communion Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Confirmation 2nd Child – School of AttendanceAge*Date of Birth* MM slash DD slash YYYY Place of Birth*Sacraments Received* None Baptism First Communion If 2nd Child is Baptized, Enter NAME & PLACE of Church*If 2nd Child Has Had First Holy Communion, Enter NAME & PLACE of Church*Is this child taking any type of medication?* No Yes If "Yes" please describe*Is this child allergic to any medication?* No Yes If "Yes" please describe*3rd CHILDFirst Name*Middle NameLast Name*Grade* Pre-K Kindergarten Grade 1 First Communion Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Confirmation 3rd Child – School of AttendanceAge*Date of Birth* MM slash DD slash YYYY Place of Birth*Sacraments Received* None Baptism First Communion If 3rd Child is Baptized, Enter NAME & PLACE of Church*If 3rd Child Has Had First Holy Communion, Enter NAME & PLACE of Church*Is this child taking any type of medication?* No Yes If "Yes" please describe*Is this child allergic to any medication?* No Yes If "Yes" please describe*4th CHILDFirst Name*Middle NameLast Name*Grade* Pre-K Kindergarten Grade 1 First Communion Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Confirmation 4th Child – School of AttendanceAge*Date of Birth* MM slash DD slash YYYY Place of Birth*Sacraments Received* None Baptism First Communion If 4th Child is Baptized, Enter NAME & PLACE of Church*If 4th Child Has Had First Holy Communion, Enter NAME & PLACE of Church*Is this child taking any type of medication?* No Yes If "Yes" please describe*Is this child allergic to any medication?* No Yes If "Yes" please describe*EMERGENCY CONTACTSPrimary Contact – Full Name*Primary Contact – Relationship to Child* Mother Father Relative Friend Primary Contact – Phone*Additional Emergency Contact NameRelationship to Child Mother Father Relative Friend PhoneAdditional Emergency Contact NameRelationship to Child Mother Father Relative Friend PhoneDoctor's Name*Doctor's Phone*In the event of an emergency, if we are unable to reach any of the above contacts, do you give Ascension Church Religious Education permission to take your child/children to the Emergency Room at Boca Raton Regional Hospital?* Yes No Enter your full name, acknowledging that all information entered in this form is complete and accurate.*CAPTCHACopy of Baptismal Certificate for each child MUST be submitted to Parish Office prior to admission to class.Please review information carefully then submit. A confirmation will be sent to your email address. Please remember to pay the Family fee of $100.00 to complete the registration process.
