Online Registration for 2021-2022

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

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

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.

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

Secondary Phone Number (optional) Please enter a phone number.

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

Secondary Email (optional) Please enter an email address.

Emergency Contact Information

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
Emergency Contact Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

Child Number One

First Name REQUIRED Please fill out this field. Please enter valid data.
Last Name REQUIRED Please fill out this field. Please enter valid data.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Grade REQUIRED Please fill out this field. Please enter valid data.
Program REQUIRED Faith Formation K-8 First Reconciliation & Communion Preparation Confirmation Preparation Please fill out this field.

Child Number Two

First Name Please enter valid data.
Last Name Please enter valid data.
Date of Birth Please enter a date.
Grade Please enter valid data.
Program Faith Formation K-8 First Reconciliation & Communion Preparation Confirmation Preparation

Child Number Three

First Name Please enter valid data.
Last Name Please enter valid data.
Date of Birth Please enter a date.
Grade Please enter valid data.
Program Faith Formation K-8 First Reconciliation & Communion Preparation Confirmation Preparation

Child Number Four

First Name Please enter valid data.
Last Name Please enter valid data.
Date of Birth Please enter a date.
Grade Please enter valid data.
Program Faith Formation K-8 First Reconciliation & Communion Preparation Confirmation Preparation

Additional Information

Please include any additional information or special needs you would like us to be aware of.

St. Robert Bellarmine Parish