Registration - Religious Education - Saint Patrick Church

Child's First Name REQUIRED Please fill out this field. Please enter valid data.

Child's Last Name REQUIRED Please fill out this field. Please enter valid data.

Birthdate REQUIRED Please fill out this field. Please enter valid data.

Age REQUIRED Please fill out this field. Please enter valid data.

Grade REQUIRED Please fill out this field. Please enter valid data.

Gender Male Female

Street Address REQUIRED Please fill out this field.

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 Please fill out this field. Please enter a phone number.

Health Issues/Special Needs

Was child Baptized? REQUIRED Yes No Please fill out this field.

If Baptized, please indicate the date, Church Name, and City/State of Church. If baptized at a parish other than St. Patrick, the Baptism certificate is required.

Did child receive First Communion? REQUIRED Yes No Please fill out this field.

When and where did your child receive their First Communion? Please enter valid data.

Was child confirmed? REQUIRED Yes No Please fill out this field.

When and where was your child confirmed? Please enter valid data.

Is family registered at St. Patrick Church? REQUIRED Yes No Please fill out this field.

Was your family registered at St. Patrick Church last year? REQUIRED Yes No Please fill out this field.

Father's Full Name and address Please enter valid data.

Father's Email Please enter an email address.

Father's cell phone number and carrier Please enter valid data.

Mother's Maiden Name and address Please enter valid data.

Mother's email address Please enter valid data.

Mother's cell phone number and carrier Please enter valid data.

Please provide which email and phone number you check the most often. REQUIRED Please fill out this field. Please enter valid data.

May we send text messages to cell phones? Yes No

Saint Patrick Catholic Church
219 S. Beaver Street York Pa

(717) 848-2007

Registration - Religious Education

Religious Education On-Line Registration
Please complete one form for each child

Religious Education Flocknote Email/Text Alert