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  • Family 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 AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • Preferred Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  • Email: (Allows us to lesson costs to provide timely infomation) REQUIRED Please fill out this field. Please enter an email address.

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    Parent(s) or Guardian(s) The Student Lives With
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
  • Religion REQUIRED Please fill out this field. Please enter valid data.
  • Preferred Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Relationship to Child Please enter valid data.
  • Religion Please enter valid data.
  • Preferred Phone Number Please enter a phone number.

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    STUDENT INFORMATION
  • 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 valid data.
  • Gender REQUIRED Male Female Please fill out this field.
  • Sacraments Recieved (Provide date, Church & State in Comments) REQUIRED Baptism Reconciliation Eucharist Confirmation RCIA Please fill out this field.
  • Comments or Request to Set Up Appointment
  • Name of School Attending this Year REQUIRED Please fill out this field. Please enter valid data.
  • Grade Level in School REQUIRED Please fill out this field. Please enter valid data.
  • Name of IEP (if any) and any Special Accomodations required Please enter valid data.
  • Enrolling in REQUIRED Early Childhood Program, age 3 as of Sept 5 Parish School of Religion Please fill out this field.
  • Students Previous Formal Religious Education ((Indicate grades and Last Church Providing Religous Ed. REQUIRED Please fill out this field.
  • Please provide documentation of previous religious education if not at St Luke.

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