2nd Grade First Holy Communion Prep Registration – Epiphany of the Lord Catholic Parish

Name of Child Preparing for First Communion*
First Middle Last
Name of Father Listed on Baptismal Certificate*
First Middle Last
Maiden Name of Mother Listed on Baptismal Certificate*
First Middle Last
Please do not list mother’s married name. In the last name box, please ensure the maiden name is written.
Child's Birth Date*
Month
Day
Year
Child's Baptismal Date (approximate)*
Where was child baptized?*
If child was not baptized at Epiphany of the Lord, please provide name of church, city, and state where church of baptism is located
Schooling*
Please list/describe any health concerns or learning issues that may require accommodations in regards to learning/preparing for the sacraments or receiving the sacraments. We will work within your child's needs and abilities to prepare him/her.*
Parent 1/Primary Parent*
First Last
Child's Primary Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent 1 Email address*
Parent 1 Phone*
Secondary Parent/Parent 2*
First Last
Address if different from parent 1
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email address if different from parent 1
Parent 2 Phone*
Please ensure that all required fields (marked with a star) are filled out. If you hit submit and were not redirected to a new page, please scroll to the top of the form to see which areas you may have missed.

Please ensure that all required fields (marked with a star) are filled out. If you hit submit and were not redirected to a new page, please scroll to the top of the form to see which areas you may have missed.