2025-2026 Religious Education Registration

The parents/guardians of all students enrolling in the PYC program must be registered, active members of
Our Lady of Lourdes Parish.
By completing this registration, you are confirming that you are an active, registered member.
If you are unsure of your status, contact the parish office.

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Primary Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Parent/Guardian 1

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

* I am interested in serving the program as a volunteer catechist or classroom aide.

Parent/Guardian 2

First Name Please enter valid data.

Last Name Please enter valid data.

Email Please enter an email address.

Phone Number Please enter a phone number.

* I am interested in serving the program as a volunteer catechist or classroom aide.

Primary Emergency Contact

This is the first person we will contact in an emergency and is usually a parent or guardian.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Relationship to Student REQUIRED Please fill out this field. Please enter valid data.

Secondary Emergency Contact
In the event of an emergency, we will first attempt to reach the Primary Emergency Contact.
If that person cannot be reached, contact:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Relationship to Student REQUIRED Please fill out this field. Please enter valid data.

Number of Children to Enroll in Religious Education REQUIRED Please fill out this field.
Child Name 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter a date.
- * REQUIRED Male Female Please fill out this field.
- Year Baptism Received REQUIRED Please fill out this field.
- Church of Baptismal Record REQUIRED Please fill out this field. Please enter valid data.
- Year First Communion Received REQUIRED Please fill out this field.
- 2025-2026 School Year Grade REQUIRED Please fill out this field.
- Preferred Class Section REQUIRED Please fill out this field.
- The Parish will take reasonable care to see that the following information will be held in confidence. The DRE should be aware of these special medical conditions:
- My child requires the following classroom modifications:
- Please list any other comments or concerns regarding your child that will help him/her to be successful in our PYC program this year.
Child Name 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter a date.
- * REQUIRED Male Female Please fill out this field.
- Year Baptism Received REQUIRED Please fill out this field.
- Church of Baptismal Record REQUIRED Please fill out this field. Please enter valid data.
- Year First Communion Received REQUIRED Please fill out this field.
- 2025-2026 School Year Grade REQUIRED Please fill out this field.
- Preferred Class Section REQUIRED Please fill out this field.
- The Parish will take reasonable care to see that the following information will be held in confidence. The DRE should be aware of these special medical conditions:
- My child requires the following classroom modifications:
- Please list any other comments or concerns regarding your child that will help him/her to be successful in our PYC program this year.
Child Name 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter a date.
- * REQUIRED Male Female Please fill out this field.
- Year Baptism Received REQUIRED Please fill out this field.
- Church of Baptismal Record REQUIRED Please fill out this field. Please enter valid data.
- Year First Communion Received REQUIRED Please fill out this field.
- 2025-2026 School Year Grade REQUIRED Please fill out this field.
- Preferred Class Section REQUIRED Please fill out this field.
- The Parish will take reasonable care to see that the following information will be held in confidence. The DRE should be aware of these special medical conditions:
- My child requires the following classroom modifications:
- Please list any other comments or concerns regarding your child that will help him/her to be successful in our PYC program this year.
Child Name 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter a date.
- * REQUIRED Male Female Please fill out this field.
- Year Baptism Received REQUIRED Please fill out this field.
- Church of Baptismal Record REQUIRED Please fill out this field. Please enter valid data.
- Year First Communion Received REQUIRED Please fill out this field.
- 2025-2026 School Year Grade REQUIRED Please fill out this field.
- Preferred Class Section REQUIRED Please fill out this field.
- The Parish will take reasonable care to see that the following information will be held in confidence. The DRE should be aware of these special medical conditions:
- My child requires the following classroom modifications:
- Please list any other comments or concerns regarding your child that will help him/her to be successful in our PYC program this year.
Child Name 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter a date.
- * REQUIRED Male Female Please fill out this field.
- Year Baptism Received REQUIRED Please fill out this field.
- Church of Baptismal Record REQUIRED Please fill out this field. Please enter valid data.
- Year First Communion Received REQUIRED Please fill out this field.
- 2025-2026 School Year Grade REQUIRED Please fill out this field.
- Preferred Class Section REQUIRED Please fill out this field.
- The Parish will take reasonable care to see that the following information will be held in confidence. The DRE should be aware of these special medical conditions:
- My child requires the following classroom modifications:
- Please list any other comments or concerns regarding your child that will help him/her to be successful in our PYC program this year.
Child Name 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter a date.
- * REQUIRED Male Female Please fill out this field.
- Year Baptism Received REQUIRED Please fill out this field.
- Church of Baptismal Record REQUIRED Please fill out this field. Please enter valid data.
- Year First Communion Received REQUIRED Please fill out this field.
- 2025-2026 School Year Grade REQUIRED Please fill out this field.
- Preferred Class Section REQUIRED Please fill out this field.
- The Parish will take reasonable care to see that the following information will be held in confidence. The DRE should be aware of these special medical conditions:
- My child requires the following classroom modifications:
- Please list any other comments or concerns regarding your child that will help him/her to be successful in our PYC program this year.
Child Name 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter a date.
- * REQUIRED Male Female Please fill out this field.
- Year Baptism Received REQUIRED Please fill out this field.
- Church of Baptismal Record REQUIRED Please fill out this field. Please enter valid data.
- Year First Communion Received REQUIRED Please fill out this field.
- 2025-2026 School Year Grade REQUIRED Please fill out this field.
- Preferred Class Section REQUIRED Please fill out this field.
- The Parish will take reasonable care to see that the following information will be held in confidence. The DRE should be aware of these special medical conditions:
- My child requires the following classroom modifications:
- Please list any other comments or concerns regarding your child that will help him/her to be successful in our PYC program this year.
Child Name 8
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter a date.
- * REQUIRED Male Female Please fill out this field.
- Year Baptism Received REQUIRED Please fill out this field.
- Church of Baptismal Record REQUIRED Please fill out this field. Please enter valid data.
- Year First Communion Received REQUIRED Please fill out this field.
- 2025-2026 School Year Grade REQUIRED Please fill out this field.
- Preferred Class Section REQUIRED Please fill out this field.
- The Parish will take reasonable care to see that the following information will be held in confidence. The DRE should be aware of these special medical conditions:
- My child requires the following classroom modifications:
- Please list any other comments or concerns regarding your child that will help him/her to be successful in our PYC program this year.

Registration Fee (After 9/1, an additional $20 late registration fee per child is applied)95.0

Total children enrolled in Religious Education this year: Please enter an integer (number).

I would like to help cover credit card transaction fees. REQUIRED 5.0 – Yes 0.0 – No Please fill out this field.

Permission
I am the parent or legal guardian of the named children and have full legal responsiblity for them. I grant permission for the listed children to participate in CGS or PYC at Our Lady of Lourdes, Marysville, for the 2025-2026 academic year.