Registration for First Reconciliation & First Communion

Full Name of Child for Registering(required)

Date of Birth (day-month-year)(required)

Place of Baptism (Name and City of Church)(required)

Date of Baptism (day-month-year)(required)

School the child attends(required)

Grade Level of Child(required)

Primary Address (street address line 1)(required)

Primary Address (street address line 2)

City and Province(required)

Postal Code(required)

Home Phone Number (incl. area code)(required)

Cell Phone Number (incl. area code)

Are you willing to receive text messages at this number?(required) Yes

No

Email #1(required)

Email #2

Mother's Full Name(required)

Mother's Maiden Name(required)

Mother's Religion(required)

Mother's Church of Baptism (name of church and city IF applicable)

Father's Full Name(required)

Father's Religion(required)

Father's Church of Baptism (name of church and city IF applicable)

We primarily attend Church at:(required) Visitation Parish Comber

St. Francis Xavier Tilbury

St. Simon and St. Jude Belle River

St. John's Woodslee

Other Catholic Church

Is your family currently registerd as members of Visitation Parish?(required) Yes

No

Not Sure

If your family is not registered at Visitation Parish would you like to be? Yes

No

Does your child have any special needs of which we should be aware? Please explain