IC RELIGIOUS EDUCATION REGISTRATION FORM 2025-2026

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– Step 1 of 4

Phone Maiden a

Parent Information

Father's Name *

First

Middle

Last

Father's Email *

Father's Phone *

Mother's Name *

First

Middle

Last

Mother's Email *

Mother's Phone *

Maiden Name *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Student Information

Child's Full Name *

First

Middle

Last

Date of Birth *

Place of Birth City/State *

School Grade *

Last attended Religious ED grade *

Baptism

If the Sacrament of Baptism was received, please list the name and address of the Church.

First Communion

If the Sacrament of First Communion was received, please list the name and address of the Church.

Allergies

Please inform us if you will be bringing in an epi-pen or inhaler before class.

Special Needs

Does your child have any special needs or medical conditions that we should be aware of?

Emergency Contact

Emergency Contact Name *

First

Last

Emergency Contact Email *

Enter the emergency contact’s email.

Emergency Contact Phone

Enter the emergency contact’s phone number.

Emergency Contact Relationship to the Child

Select the emergency contact’s relationship to the child.

Fees

# of Children	Grade	FEE
1	1, 3 through 7	$100.00
1	2 (First Communion)	$125.00
2	1, 3 through 7	$155.00
3 or more	1, 3 through 7	$200.00
1	8 (Confirmation)	$180.00

Based on the Religious Education Fee Will you need to a payment plan? *

Yes, I plan to pay a little every month
No, I plan to pay in full at the beginning of the year

Do you plan on taking on active roll in your child’s Religious Development? *

*****Any parent who sign up to teach or assist on Sunday morning will receive free tuition for 1 child.

Please Note if you are having someone other than yourselves pick up your child/children you must call or send a note!!

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Immaculate Conception Church