Religious Education

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

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

Birthdate REQUIRED

MM-DD-YEAR

Please fill out this field. Please enter valid data.

Age REQUIRED Please fill out this field. Please enter an integer (number).

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

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Gender REQUIRED Male Female Please fill out this field.

Street 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.

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.

Saint Patrick Catholic Church
219 S. Beaver Street York Pa

(717) 848-2007

Religious Education

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