St. Michael Roman Catholic Church
Religious Education
Student Permanent Record

Date record begun    

                                                                               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 the space below to describe the situation

School currently attending Grade

Sacramental Information
Complete the following if appicalbe. Include the diocese of each church.

Date of Baptism   Church   Diocese

Date of 1st Reconciliation  Church    Diocese

Date of 1st Eucharist    Church    Diocese

Date of Confirmation      Church   Diocese

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