Religious Education and Confirmation Registration - St. Vianney Catholic Church

Child's Name as shown on Baptismal Certificate

Name *

Date of Birth *

Date of Baptism *

Church of Baptims *

School Attending *

Grade Level *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Father's Name (First, Middle, Last) *

Religion *

Phone Number *

Email *

Mother's Name (First, Middle, Maiden) *

Religion *

Phone Number *

Email *

Emergency Contact Name *

Phone Number *

Allergies *

Yes No

Submit