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 Name Last 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 Attendance Age* 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 Name Last 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 Attendance Age* 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 Name Last 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 Attendance Age* 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 Name Last 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 Attendance Age* 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 Name Relationship to Child Mother Father Relative Friend PhoneAdditional Emergency Contact Name Relationship 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.
