Previously Registered

Religious Education Registration

         School Year:_________
St. Mary of the Assumption
P.O. Box 129
Cambridge, Vt 05444 (802) 644-5073
Family Name: Father's Name: Mother's Name:
Mailing Address: Street Address:
City: Zip:
Home Phone: Emergency Phone:

Child's Name: Grade:
Child's Name: Grade:
Child's Name: Grade:
Child's Name: Grade:
New Child's Name: Date of Birth:
   Grade: Gender:    Male / Female Place of Birth:
   Date of Baptism: Name of Church: Church Address:
   Date of First Communion: Name of Church: Church Address:
   Child's Special Interests:
   Any Allergies?
   Previous Religious Instruction:    Yes / No Where?
* Use Back for additional registrations

How can you assist the Religious Education Program?
Catechist Substitute Teacher Teacher's Assistant Cleanup after class Other:_____________________

Registration Fee is $20 (1 child), $30 (2 children) or $40 per family
Make Checks payable to: St. Mary's Church and include payment with this application!

Signature:__________________________________________________ Date: ___________________
For Office use only:
Date Received: Check Number: Amount Received: