Jr High Online Registration Form

Please complete the following parent information. We must have valid phone numbers for the parent or guardian that will be responsible for getting the child/ren to and from religion class. In the comment area below, please list any additional family members that may be contacted and their phone numbers.

Father's Full Name REQUIRED Please fill out this field. Please enter valid data.

Father's Profession Please enter valid data.

Father's Cell Phone Please enter valid data.

Father's Religion Please enter valid data.

Mother's Full Name (Maiden) REQUIRED Please fill out this field. Please enter valid data.

Mother's Profession Please enter valid data.

Mother's Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Mother's Religion Please enter valid data.

Physical Address REQUIRED Please fill out this field. Please enter valid data.

Mailing Address (if different) Please enter valid data.

Primary Email Address for Notifications REQUIRED Please fill out this field. Please enter valid data.

Additional Email Addresses for Notifications

Additional Phone Numbers

The St. Rita Religious education software program gives us the ability to text out information to parents throughout the day for reminders or notifications. If you would like to receive occasional text messages concerning your child's CCD program, please provide us with your permission and cell phone carrier. The majority of carriers are recognized, however if your carrier is not, I will notify you.

I give St. Rita Church permission to send text messages to my cell phone. REQUIRED Yes No Please fill out this field.

Primary Cell Phone Number Please enter valid data.

Cell Phone Carrier Please enter valid data.

I give my permission to St. Rita Catholic Church to take pictures of child/ren on various occasions throughout the year. Yes No

Please type name below for permission. Please enter valid data.

Please fully complete the following information for each child you are registering. At the end of the form, you will need to follow the attached link to pay the appropriate fee. If you have any questions, please call Courtney Brinkman at 318-445-7141 x 217.

Child's Full Name REQUIRED Please fill out this field. Please enter valid data.

The child resides with: REQUIRED Both Parents Mother Father Other Please fill out this field.

If other, please state who the child lives with. Please enter valid data.

FOR JUNIOR HIGH ONLY: Please provide an email address and cell number for the student.

Gender Male Female

School Attending REQUIRED Please fill out this field. Please enter valid data.

Grade REQUIRED Please fill out this field. Please enter valid data.

Age REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Is the child baptized? Yes No

Church, City and State of Baptism Please enter valid data.

Has the child received First Communion? REQUIRED Yes No Please fill out this field.

Has the child received First Confession? REQUIRED Yes No Please fill out this field.

Has the child received Confirmation? REQUIRED Yes No Please fill out this field.

Is there anything special that we should know about your child or his/her previous religious education?

* If you have another child to register, please continue. If not, please scroll to the bottom of the form and follow the payment link.

Child's Full Name Please enter valid data.

The child resides with: Both Parents Mother Father Other

If other, please state who the child lives with. Please enter valid data.

Gender Male Female

School Attending Please enter valid data.

Grade Please enter valid data.

Age Please enter valid data.

Date of Birth Please enter valid data.

Is the child baptized? Yes No

Church, City and State of Baptism Please enter valid data.

Has the child received First Communion? Yes No

Has the child received First Confession? Yes No

Has the child received Confirmation? Yes No

Is there anything special that we should know about your child or his/her previous religious education?

* If you have another child to register, please continue. If not, please scroll to the bottom of the form and follow the payment link.

Child's Full Name Please enter valid data.

The child resides with: Both Parents Mother Father Other

If other, please state who the child lives with. Please enter valid data.

Gender Male Female

School Attending Please enter valid data.

Grade Please enter valid data.

Age Please enter valid data.

Date of Birth Please enter valid data.

Is the child baptized? Yes No

Church, City and State of Baptism Please enter valid data.

Has the child received First Communion? Yes No

Has the child received First Confession? Yes No

Has the child received Confirmation? Yes No

Is there anything special that we should know about your child or his/her previous religious education?

After submitting your form, please follow the link to process your payment. Registration is not complete until payment is received.

Thank you for registering your child and we look forward to a great year. The guidelines and calendar are both listed under Religious Education for your convenience.