Grade 2 Parents in the Religious Education Program are to complete this form to enter their child’s information in the Parish First Eucharist Register. Please complete by November 30. Thank you!!

Primary Family Email

Child's Baptismal Name (First / Middle / Last)

Date of Birth

YYYY

Gender

Male

Female

City / State of Birth

Father (Full Legal Name)

Mother (Include Maiden Name)

Date of Baptism

YYYY

Church of Baptism

City / State

Child's Age on First Communion Date

7 years old

8 years old

9 years old

Residence (Town Name)

Person completing form: I am requesting the sacrament of Eucharist for my child