For office use only

Paid_____Amt $______

Ck.#_________Cash___

ST. MAXIMILIAN KOLBE PARISH

SCARBOROUGH, MAINE

CATECHETICS & INITIATION REGISTRATION

Grades K-12 (Including Youth Ministry)

2007-2008 Fee: $ 55 per child

$140 per family

Family Name___________________________Father’s Name_________________Mother’s 1^st & Maiden Name__________________

Address______________________________________________________Telephone #_____________e-mail___________________

CHILDREN: (answer yes or no)

FIRST LAST M/F GRADE D.O.B SCHOOL BAPTIZED RECONC. EUCH. CONF.

NAME NAME ATTDNG.

èFor those making Confirmation & First Eucharist this year: Was your child Baptized at St. Maximilian Kolbe? Yes No If so, when? _____________ For those NOT Baptized here, Baptism Certificates must be brought in at time of registration.

Person to contact in case of emergency (other than parents):

Name:______________________________________________Address:________________________________Phone #__________________________

Are there any allergies, learning disabilities, handicaps or problems of which you wish to inform us?

Other comments?_____________________________________________________________________________________________________________