Saint Michael Roman Catholic Church

Religious Education

Student Permanent Record

Date _______________

General Information

Child’s Name __________________________________________________________________

(Last) (First) (Middle)

Address ______________________________________________________________________

(Street) (City) (State) (Zip)

Phone ___________________________ Email ______________________________

Date of Birth ______________________ Place of Birth _____________________ Sex _____

Name of Father _______________________________________ Work Phone _____________

Maiden Name of Mother __________________________________ Work Phone ____________

If parents are separated, divorced or deceased, or if the child lives with someone other than the natural parents; or if there are other special circumstances (such as physical or learning disability) use this space to describe the situation

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

School currently attending __________________________________ Grade ____________

Sacramental Information

Complete the following if applicable. Include the diocese of each church.

Date of Baptism _____________________ Church ___________________________________

Date of 1^st Reconciliation ______________ Church ___________________________________

Date of 1^st Eucharist __________________ Church ___________________________________

Date of Confirmation _________________ Church ___________________________________

**A copy of the Baptismal Certificate must be on file in the Faith Formation Office.**