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Religious Education Registration

Download Religious Education Registration Form

Father
Father’s/Guardian Full Name
Religion
Home #
Work #
Cell #
Receive Text?

Yes No
Street Address
City
Zip
Mother
Mother’s/Guardian Full Name
Religion
Home #
Work #
Cell #
Receive Text?

Yes No
Street Address
City
Zip
General Information
Mother's Maiden Name
Contact Email
Child/Children live with

Both Parents Father Mother
Preferred way to receive information

Postal Mail E-Mail Text
Emergency Contact Name
Phone #
Children Information

	Child 1	Child 2	Child 3	Child 4
Child's Name (First, Last)
Male/Female
Birthday M/D/Y
Grade
School
Baptism (Yes/No)
Reconciliation (Yes/No)
Communion (Yes/No)
Confirmation (Yes/No)

Sacrament Information
First Reconciliation and First Communion is a two year program.

Year 1 (pre-requisite - 1st Grade) Year 2 (2nd Grade)
Confirmation is a two year program.

Year 1 (pre-requisite - 10th Grade) Year 2 (11th Grade)
If not already on file at St. Cecilia, please attach a copy of your child's Baptismal Certificate.
Filename
Status
Size
Add Files
Medical Release
It is our goal to meet the needs of all students. Please respond to the following questions. All information is confidential.
1. Did your child/children attend Religious Education classes at St. Cecilia last year?

Yes No
If no, where did your child/children attend Religious Education?
2. Does your child/children have special needs?

Yes No
If yes, please list: (name)
3. Does your child/children have allergies?

Yes No
If yes, please list: (name)
4. Does your child/children take medications?

Yes No
If yes, please list: (name)
5. Does your child/children have a learning disability?

Yes No
If yes, please explain: (name)
Physician/Insurance Information
Physician Name
Telephone #
Preferred Hospital
Address
City
Zip
Insurance Company
Telephone #
Policy Carrier
Policy #
Group #
Virtual Signature
I/We, the undersigned parent(s) or legal guardian(s) of
do hereby authorize any x-ray examination, anesthetic, dental, medical or surgical diagnosis or treatment by any licensed physician or dentist and/or hospital service that may be rendered to said minor(s) under the general, specific or special request of Religious Education Department staff. This consent will remain in effect from September 1, 2019 until August 31, 2020. I understand that every precaution will be taken to ensure my son(s)/daughter(s)/ward(s) safety. Should an accident occur, I will not hold the Church of St. Cecilia or the Diocese of Tulsa or its paid staff or volunteer staff responsible. Further, I understand that attempts will be made to immediately contact me should an accident occur. I understand that an ambulance or emergency personnel will be requested if deemed necessary. Payment for medical/dental emergencies is the sole responsibility of the parent(s)/guardian(s).
Signature: Parent/Guardian
Date
Month - Day - Year
Signature: Parent/Guardian
Date
Month - Day - Year
Captcha

Grades Pre-K through 8
Life Teen
RCIA
Religious Education Registration
Annual Youth Registration
Religious Formation Handbook

Quick Links

Contact Information

St. Cecilia Catholic Church
1304 North Dorothy Ave
Claremore, OK 74017

Email: stceciliachurch1304@gmail.com

Parish Office: 918-341-2343
Fax: 918-343-2893

Religious Education Registration

Religious Education Registration

Father

Mother

General Information

Children Information

Sacrament Information

Medical Release

Virtual Signature

Contact Information