Children

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Primary Language Spoken REQUIRED Please fill out this field.

Home Information REQUIRED Please fill out this field.

Personal or custodial issues: Please enter valid data.

Emergency Contact REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Are you an active & registered parishioner at St. Peter Church? REQUIRED yes no Please fill out this field.

If not, what parish do you belong to? Please enter valid data.

Student information

Student #1 name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED

mm/dd/yyyy

Please fill out this field. Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Name of School REQUIRED Please fill out this field. Please enter valid data.

Grade in the Fall of 2022 REQUIRED Please fill out this field. Please enter an integer (number).

Please list any allergies, medical conditions, physical limitations, special needs or learning disabilities for the RE Director. Please enter valid data.

Sacraments received (check all that apply) REQUIRED Baptism Reconciliation First Communion Confirmation Please fill out this field.

Student #2 name Please enter valid data.

Date of Birth

mm/dd/yyyy

Please enter valid data.

Gender Male Female

Name of School Please enter valid data.

Grade in the Fall of 2022 Please enter an integer (number).

Please list any allergies, medical conditions, physical limitations, special needs or learning disabilities for the RE Director. Please enter valid data.

Sacraments received (check all that apply) Baptism Reconciliation First Communion Confirmation

Student #3 name Please enter valid data.

Date of Birth

mm/dd/yyyy

Please enter valid data.

Gender Male Female

Name of School Please enter valid data.

Grade in the Fall of 2022 Please enter an integer (number).

Please list any allergies, medical conditions, physical limitations, special needs or learning disabilities for the RE Director. Please enter valid data.

Sacraments received (check all that apply) Baptism Reconciliation First Communion Confirmation

Roman Catholic Church of St. Peter

915 Sard Ave. Aurora, IL

Children

Family Religious Education Program 2022-23

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