ST. Michael Catholic Church

RELIGIOUS EDUCATION REGISTRATION 2012 - 2013   9:15 AM to 10:30 AM

Parents’ Names: Mother: ________________________Father:________________________________

Child’s last name if different: ____________________________________

Address: _______________________________________________________________

City _________________________ Zip ________________

Home Phone: ________________________________

E-mail: _____________________________________________

Mother Cell Phone: _________________       Father Cell Phone: ________________

Emergency Contact if above cannot be reached _______________________

Phone _______________________

List ALL Children you are enrolling in Religious Education Program. CHECK SACRAMENTS RECEIVED

_____ My child/children were enrolled in religious education classes last year at Saint Michael’s.

_____ My children were enrolled last year at____________________________________Parish.

_____ My children were not enrolled in religious education classes last year.

Please list any allergies:

Please write any special concerns.  You may use the back of this page.

1.   Rev. Thomas J. Peyton Pastor   email:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it    phone: 912-786-4505

2.   Fretwell Crider Deacon, Retired

3.  Sr. Barbara Shimkus, RSM  Pastoral Assistant  email:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it   phone:  912-786-4505

4.   Ms. Mary Chapin, Office Manager  email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it   phone:  912-786-4505

5.   Mrs. Susan Weber, PREP/Youth Director  email:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it   phone:  912-786-0642