ALL Students &lt;div&gt; CCD &lt;span&gt;Registration Form&lt;/span&gt; &lt;/div&gt;

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SAINT ELIZABETH SETON PARISH
4900 Reilly Road
Ocean Springs, Mississippi 39564
Fee35.0
Diocese of Biloxi
RELIGIOUS EDUCATION PERMAMENT RECORD FORM
PARENT / GUARDIAN INFORMATION
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Mailing 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.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Type of Phone
- Email REQUIRED Please fill out this field. Please enter an email address.
- If mother, Maiden Name Please enter valid data.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Occupation REQUIRED Please fill out this field. Please enter valid data.
ADDITIONAL PARENT / GUARDIAN INFORMATION
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Relationship to Child
- If mother, Maiden Name Please enter valid data.
- Religion Please enter valid data.
- Occupation Please enter valid data.
- No of Children REQUIRED Please fill out this field.
- CHILD 1
  - Grade Entering REQUIRED Please fill out this field.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Relationship to Child REQUIRED Please fill out this field.
  - Mailing Address (if different from parent/guardian) Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Phone Number Maximum 20 characters Please enter a phone number.
  - Type of Phone
  - Email Please enter an email address.
  - SACRAMENTS
  - BAPTISM
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  - Date of Baptism Please enter a date.
  - Church of Baptism Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST RECONCILIATION
  - First Reconciliation Yes No
  - Church of First Reconciliation Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST EUCHARIST
  - Date of First Eucharist Please enter a date.
  - Church of First Eucharist Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Is the child interested in serving as an Altar Server? The child must have made his or her first Eucharist and be in 3rd grade or above. Yes No
- CHILD 2
  - Grade Entering REQUIRED Please fill out this field.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Relationship to Child REQUIRED Please fill out this field.
  - Mailing Address (if different from parent/guardian) Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Phone Number Maximum 20 characters Please enter a phone number.
  - Type of Phone
  - Email Please enter an email address.
  - SACRAMENTS
  - BAPTISM
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  - Date of Baptism Please enter a date.
  - Church of Baptism Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST RECONCILIATION
  - First Reconciliation Yes No
  - Church of First Reconciliation Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST EUCHARIST
  - Date of First Eucharist Please enter a date.
  - Church of First Eucharist Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Is the child interested in serving as an Altar Server? The child must have made his or her first Eucharist and be in 3rd grade or above. Yes No
- CHILD 3
  - Grade Entering REQUIRED Please fill out this field.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Relationship to Child REQUIRED Please fill out this field.
  - Mailing Address (if different from parent/guardian) Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Phone Number Maximum 20 characters Please enter a phone number.
  - Type of Phone
  - Email Please enter an email address.
  - SACRAMENTS
  - BAPTISM
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  - Date of Baptism Please enter a date.
  - Church of Baptism Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST RECONCILIATION
  - First Reconciliation Yes No
  - Church of First Reconciliation Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST EUCHARIST
  - Date of First Eucharist Please enter a date.
  - Church of First Eucharist Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Is the child interested in serving as an Altar Server? The child must have made his or her first Eucharist and be in 3rd grade or above. Yes No
- CHILD 4
  - Grade Entering REQUIRED Please fill out this field.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Relationship to Child REQUIRED Please fill out this field.
  - Mailing Address (if different from parent/guardian) Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Phone Number Maximum 20 characters Please enter a phone number.
  - Type of Phone
  - Email Please enter an email address.
  - SACRAMENTS
  - BAPTISM
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  - Date of Baptism Please enter a date.
  - Church of Baptism Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST RECONCILIATION
  - First Reconciliation Yes No
  - Church of First Reconciliation Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST EUCHARIST
  - Date of First Eucharist Please enter a date.
  - Church of First Eucharist Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Is the child interested in serving as an Altar Server? The child must have made his or her first Eucharist and be in 3rd grade or above. Yes No
- CHILD 5
  - Grade Entering REQUIRED Please fill out this field.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Relationship to Child REQUIRED Please fill out this field.
  - Mailing Address (if different from parent/guardian) Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Phone Number Maximum 20 characters Please enter a phone number.
  - Type of Phone
  - Email Please enter an email address.
  - SACRAMENTS
  - BAPTISM
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  - Date of Baptism Please enter a date.
  - Church of Baptism Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST RECONCILIATION
  - First Reconciliation Yes No
  - Church of First Reconciliation Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST EUCHARIST
  - Date of First Eucharist Please enter a date.
  - Church of First Eucharist Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Is the child interested in serving as an Altar Server? The child must have made his or her first Eucharist and be in 3rd grade or above. Yes No
- CHILD 6
  - Grade Entering REQUIRED Please fill out this field.
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Relationship to Child REQUIRED Please fill out this field.
  - Mailing Address (if different from parent/guardian) Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Phone Number Maximum 20 characters Please enter a phone number.
  - Type of Phone
  - Email Please enter an email address.
  - SACRAMENTS
  - BAPTISM
  - Date of Birth REQUIRED Please fill out this field. Please enter a date.
  - Place of Birth REQUIRED Please fill out this field. Please enter valid data.
  - Date of Baptism Please enter a date.
  - Church of Baptism Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST RECONCILIATION
  - First Reconciliation Yes No
  - Church of First Reconciliation Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - FIRST EUCHARIST
  - Date of First Eucharist Please enter a date.
  - Church of First Eucharist Please enter valid data.
  - City Please enter valid data.
    
    State
    
    Zip Please enter a zip code.
  - Is the child interested in serving as an Altar Server? The child must have made his or her first Eucharist and be in 3rd grade or above. Yes No
Are you interested in substituting for your child's CCD class? Yes No
Are you a registered member of Saint Elizabeth Seton Parish? Yes No
BY SUBMITTING THE FORM I hereby authorize a representative of Saint Elizabeth Seton Catholic Church (SESCC) to give consent for any and all medical care for my child while said child is in SESCC custody. I further agree to be responsible for the expenses of any such medical care or treatment, including transportation expenses, and to hold harmless and release SESCC, its pastors, employees, agents, and volunteers from any and all liability for any injury, loss, or damage to person or property that might be suffered by said child as a result of such medical treatment or care or as a result of any reasonable palliative measures that such pastors, employees, agents or volunteers might take to said child’s attendance by trained medical personnel. I further grant permission to SESCC, its pastors, employees, agents or volunteers to take and use the child’s first name, picture or photograph in all forms and manner for display, publication, advertising, promotion and any other lawful purpose. I further release hold harmless and forever discharges SESCC, its pastors, employees, agents or volunteers from any and all past and further claims, damages, liability or cost arising out of or related to the aforementioned medical care and picture uses. I am the parent or legal guardian of the child and has legal authority to execute this agreement.
I Agree Please select this field.

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ST. ELIZABETH SETON

Ocean Springs, Mississippi

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