Family Name* Home PhoneCell PhoneParent's Name: (Father)* Parent's Name: (Mother)* Work Phone: (Father)Work Phone: (Mother)Email Address Address Emergency Contact Parent's Religion (If Not Catholic): (Father) Parent's Religion (If Not Catholic): (Mother) Name & Relationship Phone # Of Emergency ContactWe are Registered Members Of Our Lady Of the Lakes Parish Yes No If not, What Parish? Check Sacraments Received For Each Child1. Youth Name Birthdate MM slash DD slash YYYY Grade School Baptism Ist Eucharist Ist Reconcilation Confirmation Medical Notes (Allergies, Medications etc) 2. Youth Name Birthdate MM slash DD slash YYYY Grade School Baptism Ist Eucharist Ist Reconcilation Confirmation Medical Notes (Allergies, Medications etc) 3. Youth Name Birthdate MM slash DD slash YYYY Grade School Baptism Ist Eucharist Ist Reconcilation Confirmation Medical Notes (Allergies, Medications etc) 4. Youth Name Birthdate MM slash DD slash YYYY Grade School Baptism Ist Eucharist Ist Reconcilation Confirmation Medical Notes (Allergies, Medications etc) WE ARE HERE TO ACCOMMODATE THE NEED OF EVERY CHILD. PLEASE NOTE ANY PHYSICAL OR LEARNING PROBLEMS (I.E. LEARNING DISABILITIES, BEHAVIORAL CONCERNS, ETC.) SO THE CATECHIST MAY BE BETTER PREPARED TO INSTRUCT YOUR CHILD. (THIS INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL.)ARE THERE ANY OTHER SITUATIONS THAT WE SHOULD BE AWARE OF?PLEASE LIST ANY SPECIAL WAYS THAT WE COULD HELP YOUR YOUTH IN THEIR EDUCATIONAL/SPIRITUAL NEEDS. Office Use OnlyDate MM slash DD slash YYYY Received By OVER Sign
