Facebook YouTube Email Phone

Registration

- Register for Religious Education
  
  Please have a copy of your child's Baptismal Certificate ready even if baptized at St. Mary's Church.
- This form is not accepting responses at this time.
  
  Family Mailing Name REQUIRED Please fill out this field. Please enter valid data.
  
  Please include salutation preferred for mailings (Mr., Mrs., Ms., Dr., Mr. & Mrs., Dr. & Dr., etc.)
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Home Address
  
  Address Line 1 REQUIRED Please fill out this field. Please enter valid data.
  
  Address Line 2 Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Father's 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.
  
  Religion Please enter valid data.
  
  Work Phone Number Maximum 20 characters Please enter a phone number.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Mother's 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.
  
  Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.
  
  Religion Please enter valid data.
  
  Work Phone Number Maximum 20 characters Please enter a phone number.
  
  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
  Marital Status of Mother and Father REQUIRED Please fill out this field.
  
  Emergency Contact Information
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Relationship Please enter valid data.
  
  Children - Please complete for each new child entering program this year. REQUIRED Please fill out this field.
  
  Child 1
  
  First Name Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Date of Birth Please enter a date.
  
  Public School Attended Please enter valid data.
  
  Grade Please enter valid data.
  
  Date of Baptism Please enter a date.
  
  Church (including address) Please enter valid data.
  
  Date of First Reconciliation Please enter a date.
  
  Date of First Eucharist Please enter a date.
  
  Church Please enter valid data.
  
  Please specify child's learning disabilities, physical handicaps, allergies, etc.
  
  Child 2
  
  First Name Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Date of Birth Please enter a date.
  
  Public School Attended Please enter valid data.
  
  Grade Please enter valid data.
  
  Date of Baptism Please enter a date.
  
  Church (including address) Please enter valid data.
  
  Date of First Reconciliation Please enter a date.
  
  Date of First Eucharist Please enter a date.
  
  Church Please enter valid data.
  
  Please specify child's learning disabilities, physical handicaps, allergies, etc.
  
  Child 3
  
  First Name Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Date of Birth Please enter a date.
  
  Public School Attended Please enter valid data.
  
  Grade Please enter valid data.
  
  Date of Baptism Please enter a date.
  
  Church (including address) Please enter valid data.
  
  Date of First Reconciliation Please enter a date.
  
  Date of First Eucharist Please enter a date.
  
  Church Please enter valid data.
  
  Please specify child's learning disabilities, physical handicaps, allergies, etc.
  
  Child 4
  
  First Name Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Date of Birth Please enter a date.
  
  Public School Attended Please enter valid data.
  
  Grade Please enter valid data.
  
  Date of Baptism Please enter a date.
  
  Church (including address) Please enter valid data.
  
  Date of First Reconciliation Please enter a date.
  
  Date of First Eucharist Please enter a date.
  
  Church Please enter valid data.
  
  Please specify child's learning disabilities, physical handicaps, allergies, etc.
  
  Child 5
  
  First Name Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Date of Birth Please enter a date.
  
  Public School Attended Please enter valid data.
  
  Grade Please enter valid data.
  
  Date of Baptism Please enter a date.
  
  Church (including address) Please enter valid data.
  
  Date of First Reconciliation Please enter a date.
  
  Date of First Eucharist Please enter a date.
  
  Church Please enter valid data.
  
  Please specify child's learning disabilities, physical handicaps, allergies, etc.
  
  Child 6
  
  First Name Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Date of Birth Please enter a date.
  
  Public School Attended Please enter valid data.
  
  Grade Please enter valid data.
  
  Date of Baptism Please enter a date.
  
  Church (including address) Please enter valid data.
  
  Date of First Reconciliation Please enter a date.
  
  Date of First Eucharist Please enter a date.
  
  Church Please enter valid data.
  
  Please specify child's learning disabilities, physical handicaps, allergies, etc.
  
  Child 7
  
  First Name Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Date of Birth Please enter a date.
  
  Public School Attended Please enter valid data.
  
  Grade Please enter valid data.
  
  Date of Baptism Please enter a date.
  
  Church (including address) Please enter valid data.
  
  Date of First Reconciliation Please enter a date.
  
  Date of First Eucharist Please enter a date.
  
  Church Please enter valid data.
  
  Please specify child's learning disabilities, physical handicaps, allergies, etc.
  
  Child 8
  
  First Name Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Date of Birth Please enter a date.
  
  Public School Attended Please enter valid data.
  
  Grade Please enter valid data.
  
  Date of Baptism Please enter a date.
  
  Church (including address) Please enter valid data.
  
  Date of First Reconciliation Please enter a date.
  
  Date of First Eucharist Please enter a date.
  
  Church Please enter valid data.
  
  Please specify child's learning disabilities, physical handicaps, allergies, etc.
  
  Child 9
  
  First Name Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Date of Birth Please enter a date.
  
  Public School Attended Please enter valid data.
  
  Grade Please enter valid data.
  
  Date of Baptism Please enter a date.
  
  Church (including address) Please enter valid data.
  
  Date of First Reconciliation Please enter a date.
  
  Date of First Eucharist Please enter a date.
  
  Church Please enter valid data.
  
  Please specify child's learning disabilities, physical handicaps, allergies, etc.
  
  Child 10
  
  First Name Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender
  
  Date of Birth Please enter a date.
  
  Public School Attended Please enter valid data.
  
  Grade Please enter valid data.
  
  Date of Baptism Please enter a date.
  
  Church (including address) Please enter valid data.
  
  Date of First Reconciliation Please enter a date.
  
  Date of First Eucharist Please enter a date.
  
  Church Please enter valid data.
  
  Please specify child's learning disabilities, physical handicaps, allergies, etc.
  
  Submit
  
  This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Church of Saint Mary

Roslyn, NY

Registration

Register for Religious Education