Please complete all of the requested information below. Note that items
 with a red asterisk * are required.


 It is to your advantage to register - by completing this form and making payment - as
 soon as possible since a class will close once the maximum enrollment is reached.

Click Submit Form to send this information to St. Raphael Church.

*Required fields

Instructions Please select your Class from the list provided.
Student 1
*First Name *Last Name
Relationship   Middle Name   Nickname
*Birth Date *Gender Female   Male
*Grade *School
*Class Choices
*Class 1
Student Remarks
  General Remarks
  Health Problems
  Misc. Information
Family Options  New Family  Update Existing Family  - ID/Env 
Parent 1
*First Name *Last Name
Maiden Name
*Gender Female   Male
Marital Status
  Parent 1 - Cell ( ) - Unlisted
  Parent 1- Email   Unlisted
Parent 2
  First Name   Last Name
Relationship   Middle Name Maiden Name
  Gender Female   Male
Marital Status
  Parent 2 - Cell ( ) - Unlisted
  Parent 2- Email   Unlisted
Family Street Address
*Line 1
  Line 2
*City
*State
*ZIP
Family Phone Numbers
*Primary ( ) - Unlisted
  Other ( ) - Unlisted
Family Email Address
*Email   Unlisted
Send Email Instead of Mail When Possible
Family Remarks
  Remarks

Click Submit Form to send this information to St. Raphael Church.

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