Our Lady of Lourdes Religious Education

225 Salt Road Enola, PA 17025

Phone (717)-732-9642 Fax (717)732-8184

Email -jennifer.kent-shank@ourladyoflourdesenola.org

 

Are you a member of Our Lady of Lourdes Parish?  Yes _____   No______

Religious Education Fees:  $60.00 (1 Child)  $90.00 (family) 

Late Fee: $15.00 dollars after 9/8/2019

 

Family Information:  To assist the Religious Education office please advise of any email, phone or address changes throughout the year.

Mother/Parent Name: ___________________________________________________

Mother’s Maiden Name:__________________________________________________

Address___________________________________________________________________

City_____________________ State__________________ Zip______________________

Email address______________________________________ Marital Status*__________________

Religion______________________________

Preferred Phone_________________________________________

Father/Parent Name:______________________________________________________

Address____________________________________________________________________

City________________________ State_________________ Zip______________________

Email Address_____________________________________ Marital Status*___________________

Religion__________________________________

Preferred Phone­­­­­­­­­­­­­­­­­­­­­­­­­­­__________________________________________

*If separated or divorced should we notify both parents via email, phone, and mailings?

_____________________________________________________________________________________

Please Print Clearly and Legibly

Student Registration:  Faith Formation Grade______________________________

First Name_____________________________ Last Name _____________________

Date of Birth____________________________ Birth City and State _________________________

School Grade 2019-2020______________ School District _____________________________

School Building ____________________________ Special Needs/Requests_________________

Sacraments Received:    Catholic Baptism Yes ______  ­­­­­­­­­  No_____________

If NO what denomination _________________________________________________________

Church of Baptism Name and address _______________________________________________

First Penance Yes________ No________

If Yes and not at Our Lady of Lourdes Enola, Church Name and Address

_____________________________________________________________________________________

First Communion Yes ___________ No___________

If Yes and not at Our Lady of Lourdes Enola, Church Name and Address

If your child is homeschooled for all subjects please enter Home school in the “School Building” area.

If you are new to our program please include a copy of your Sacramental certificates( ie. Baptism, 1st Holy Communion) with your registration.

_____________________________________________________________________________________

 

For Office Use Only

Date Received: _________________________________

Payment type___________________________________

Baptismal Certificate on File ____________________________

Emergency Form on File_________________________________

Homeschool ______________________________________________

PLEASE FILL OUT ONE FORM PER CHILD.