Registration 2022-2023

Family Information

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

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Maiden: Please enter valid data.

Home Phone REQUIRED Please fill out this field. Please enter valid data.

Cell Phone #1 REQUIRED Please fill out this field. Please enter valid data.

Cell Phone #2 Please enter valid data.

Home Address, City, Zip REQUIRED Please fill out this field. Please enter valid data.

Email Address REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone REQUIRED Please fill out this field. Please enter valid data.

Both Parents Catholic?

Number of Students Registering REQUIRED Please fill out this field.
Student Information 1
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Catholic? REQUIRED Yes No Please fill out this field.
- Grade Entering Fall 2021 REQUIRED Please fill out this field.
- Sacraments Received-Check all that Apply REQUIRED
  Please check all that apply.
  Baptism First Penance First Communion Confirmation Please fill out this field.
- Please list dates and places of received Sacraments: REQUIRED Please fill out this field.
- If baptized, was your child baptized at St. Joseph Church? Yes No
- If your child was NOT baptized at St. Joseph Church, you will need to supply a copy of their baptismal certificate at this time. If they received their First Confession/First Communion elsewhere, we will need a copy of that, too.
- You may take a picture and email to info@stjosephct.org or mail in a copy to the Parish office. Thank you!
- Have you given the parish office copies of your child's Sacrament certificates (if made elsewhere)? REQUIRED Yes No Please fill out this field.
- Special Needs: Learning disabilities, medical concerns, allergies, etc.
Student Information 2
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Catholic? REQUIRED Yes No Please fill out this field.
- Grade Entering Fall 2021 REQUIRED Please fill out this field.
- Sacraments Received-Check all that Apply REQUIRED
  Please check all that apply.
  Baptism First Penance First Communion Confirmation Please fill out this field.
- Please list dates and places of received Sacraments: REQUIRED Please fill out this field.
- If baptized, was your child baptized at St. Joseph Church? Yes No
- If your child was NOT baptized at St. Joseph Church, you will need to supply a copy of their baptismal certificate at this time. If they received their First Confession/First Communion elsewhere, we will need a copy of that, too.
- You may take a picture and email to info@stjosephct.org or mail in a copy to the Parish office. Thank you!
- Have you given the parish office copies of your child's Sacrament certificates (if made elsewhere)? REQUIRED Yes No Please fill out this field.
- Special Needs: Learning disabilities, medical concerns, allergies, etc.
Student Information 3
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Catholic? REQUIRED Yes No Please fill out this field.
- Grade Entering Fall 2021 REQUIRED Please fill out this field.
- Sacraments Received-Check all that Apply REQUIRED
  Please check all that apply.
  Baptism First Penance First Communion Confirmation Please fill out this field.
- Please list dates and places of received Sacraments: REQUIRED Please fill out this field.
- If baptized, was your child baptized at St. Joseph Church? Yes No
- If your child was NOT baptized at St. Joseph Church, you will need to supply a copy of their baptismal certificate at this time. If they received their First Confession/First Communion elsewhere, we will need a copy of that, too.
- You may take a picture and email to info@stjosephct.org or mail in a copy to the Parish office. Thank you!
- Have you given the parish office copies of your child's Sacrament certificates (if made elsewhere)? REQUIRED Yes No Please fill out this field.
- Special Needs: Learning disabilities, medical concerns, allergies, etc.
Student Information 4
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Catholic? REQUIRED Yes No Please fill out this field.
- Grade Entering Fall 2021 REQUIRED Please fill out this field.
- Sacraments Received-Check all that Apply REQUIRED
  Please check all that apply.
  Baptism First Penance First Communion Confirmation Please fill out this field.
- Please list dates and places of received Sacraments: REQUIRED Please fill out this field.
- If baptized, was your child baptized at St. Joseph Church? Yes No
- If your child was NOT baptized at St. Joseph Church, you will need to supply a copy of their baptismal certificate at this time. If they received their First Confession/First Communion elsewhere, we will need a copy of that, too.
- You may take a picture and email to info@stjosephct.org or mail in a copy to the Parish office. Thank you!
- Have you given the parish office copies of your child's Sacrament certificates (if made elsewhere)? REQUIRED Yes No Please fill out this field.
- Special Needs: Learning disabilities, medical concerns, allergies, etc.
Student Information 5
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Catholic? REQUIRED Yes No Please fill out this field.
- Grade Entering Fall 2021 REQUIRED Please fill out this field.
- Sacraments Received-Check all that Apply REQUIRED
  Please check all that apply.
  Baptism First Penance First Communion Confirmation Please fill out this field.
- Please list dates and places of received Sacraments: REQUIRED Please fill out this field.
- If baptized, was your child baptized at St. Joseph Church? Yes No
- If your child was NOT baptized at St. Joseph Church, you will need to supply a copy of their baptismal certificate at this time. If they received their First Confession/First Communion elsewhere, we will need a copy of that, too.
- You may take a picture and email to info@stjosephct.org or mail in a copy to the Parish office. Thank you!
- Have you given the parish office copies of your child's Sacrament certificates (if made elsewhere)? REQUIRED Yes No Please fill out this field.
- Special Needs: Learning disabilities, medical concerns, allergies, etc.

Additional Comments or Concerns:

Registration Fee REQUIRED 50.0 – One Child 80.0 – Two Children 95.0 – Three or more Children Please fill out this field.

ST. JOSEPH CHURCH

33 West St., Rockville, CT
860-871-1970

Registration 2022-2023

Religious Education Registration Form

Registration 2022-2023 School Year