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New Family Registration

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New Family Registration
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- Are you a registered parishioner of St. Madeline Parish REQUIRED Yes No Please fill out this field.
- Family Name REQUIRED Please fill out this field. Please enter valid data.
- Address REQUIRED Please fill out this field.
- Mother's Name (First/Middle/Last/Maiden) Please enter valid data.
- Religion Please enter valid data.
- Marital Status REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number Maximum 20 characters Please enter a phone number.
- Email Please enter an email address.
- Father's Name (First/Middle/Last) Please enter valid data.
- Religion Please enter valid data.
- Marital Status REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number Maximum 20 characters Please enter a phone number.
- Email Please enter an email address.
- Emergency Name, Phone Number & Relationship REQUIRED Please fill out this field.
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Birth Date REQUIRED Please fill out this field. Please enter valid data.
- Sex
- Race
- Name of Public School attending. REQUIRED Please fill out this field. Please enter valid data.
- Grade child will be in this September REQUIRED Please fill out this field. Please enter valid data.
- Sacraments received and where REQUIRED Please fill out this field.
- Please list any medical conditions REQUIRED Please fill out this field.
- Does your child have an IEP? If yes please give details. REQUIRED Please fill out this field.
- Has your child ever attended a Catholic School or any other PREP Program? If yes, please list names of school or parish and what grade or level.
- Do you have another new PREP student to register? Please enter valid data.
- For all other child(ren) you wish to register, please list all the information (same information is required for each child) in the box below.
- Additional children
- Registration Fee REQUIRED Please fill out this field.
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