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First Reconciliation and First Communion Registration

- Sacraments

The maximum number of form submissions has been reached. This form is currently not available.
- Please fill out the following information. *A Copy of the Candidate's Baptismal Certificate is required upon submission of this form. You can scan and email to Kathryn Heemskerk at [email protected]
- Child Information
  
  Child's First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child's Middle Name(s) REQUIRED Please fill out this field. Please enter valid data.
  
  Child's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Full Mailing Address REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Town/City of Birth Please enter valid data.
  
  Gender REQUIRED Please fill out this field. Please enter valid data.
  
  Where Child attends school REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Teacher's Name Please enter valid data.
  
  Has child been baptized? REQUIRED Please fill out this field.
  
  If "yes", please provide the following information. If "no", write "Baptism Pending" in the next 2 blanks.
  
  Place of Baptism Please enter valid data.
  
  Date of Baptism Please enter a date.
  
  Please email a picture of your child's Baptismal Certificate to Kathryn Heemskerk to [email protected], even if it is from one of our 4 parishes. If you do not have it, please contact your church of Baptism to request a copy ASAP.
  
  Emergency Contact Person & Phone Number Please enter valid data.
  
  Media Release: Our Catholic Family of Parishes in Norfolk has active social media accounts. By clicking "Yes" below, you agree to allow pictures of your child to be posted online.
  
  Media Release REQUIRED Please fill out this field.
- Mother Information
  
  Mother - First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother - Current Legal Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother - Maiden Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED
  Mother's Birth Date
  Please fill out this field. Please enter valid data.
  
  Address Please enter valid data.
  
  Please provide mailing address if different from the child receiving sacraments.
  
  Home Phone Maximum 20 characters Please enter a phone number.
  
  Cell Phone Maximum 20 characters Please enter a phone number.
  
  Email Address Please enter valid data.
  
  Religious Denomination (Catholic/Anglican?) Please enter valid data.
  
  Marital Status Please enter valid data.
  
  Church of Marriage (if applicable) Please enter valid data.
  
  Current Parish you attend REQUIRED Please fill out this field. Please enter valid data.
- Father Information
  
  Father - First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father - Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED
  Father's Birth Date
  Please fill out this field. Please enter valid data.
  
  (even if you are separated or divorced, please)
  
  Address Please enter valid data.
  
  Please provide if different from child.
  
  Home Phone Maximum 20 characters Please enter a phone number.
  
  Cell Phone Maximum 20 characters Please enter a phone number.
  
  Email Address(es) Please enter valid data.
  
  Religious Denomination (Catholic, Anglican, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status Please enter valid data.
  
  Church of Marriage (if applicable) Please enter valid data.
  
  Current Parish you attend REQUIRED Please fill out this field. Please enter valid data.
- Parish Connection:
  
  Would you like to receive Parish bulletin and other information from the family of Parishes by email? REQUIRED Please fill out this field.
  
  If yes, what email would you like it to go to? Please enter valid data.
- Please direct any questions about this registration form to
  Kathryn Heemskerk, Pastoral Minister at [email protected]
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