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Registration Form for
Sacramental Prep (2nd Graders)

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- SACRAMENTAL INFORMATION FORM 2021-22
  
  Please be sure to submit this form by Sunday, August 26.
- Child’s Full Name (as entered on Baptismal Certificate)
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name (not just initial) 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 (MM/DD/YYYY) REQUIRED Please fill out this field. Please enter valid data.
- Date of Baptism (MM/DD/YYYY) REQUIRED Please fill out this field. Please enter valid data.
- Name of Church Where Baptized REQUIRED Please fill out this field. Please enter valid data.
- Street Address of Church Where Baptized REQUIRED Please fill out this field. Please enter valid data.
- City, State, & ZIP of Church Where Baptized REQUIRED Please fill out this field. Please enter valid data.
- Parent/Guardian Information:
- Father's Full Name (First, MIddle, & Last) REQUIRED Please fill out this field. Please enter valid data.
- Mother's Full Name (First, Middle, & Maiden) REQUIRED Please fill out this field. Please enter valid data.
- Parent/Guardian Street Address REQUIRED Please fill out this field. Please enter valid data.
- City, State, & ZIP of Parent/Guardian REQUIRED Please fill out this field. Please enter valid data.
- Father's Email Address Please enter valid data.
- Mother's Email Address Please enter valid data.
- Phone Number (Father) REQUIRED Please fill out this field. Please enter valid data.
- Phone Number (Mother) REQUIRED Please fill out this field. Please enter valid data.
- Please indicate which parish you wish your child to receive the sacraments: REQUIRED Please fill out this field.
- If your child was NOT baptized at St. Joan of Arc or St. Patrick a recently issued baptismal certificate is required; please contact the parish of your child’s Baptism to request it.
  The certificate may be mailed, emailed, or faxed to St. Joan of Arc.
  Mail to: Saint Joan of Arc Catholic Church, Attn: Tami Maurer, 3155 South 200 West, Kokomo, IN 46902.
  Fax to: (765) 865-6683 to the attention of Tami Maurer.
  Email to: tmaurer@parish.dol-in.org
- PHOTO RELEASE
  By registering, I am granting permission to use my child's likeness in a photograph in any and all publications and materials without payment and consideration made to me.
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St. Patrick Church

Kokomo, Indiana

Registration Form for
Sacramental Prep (2nd Graders)

Registration Form for Sacramental Prep (2nd Graders)

Registration Form for
Sacramental Prep (2nd Graders)