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Religious Education Form

Saint Mary Catholic Church – Religious Education Form
8343 Woolmarket Road, Biloxi, MS 39532
228-392-1999 (Office) 228-392-4552 (Fax)

Fees:
1 child: $20.00
2 children: $40.00
3 or more: $50.00
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- Religious Education Form
- School Year: Maximum 12 characters Please enter valid data.
- K thru 6th Grade
  Brandy Kopszywa 228-860-4160
- Receiving 1st Holy Communion? Yes No
- (If yes, please attach a copy of your Baptismal certificate.)
- Edge® (7^th- 8th Grade)
  Emily Cloud 228-424-7292
- Life Teen® (9^th- 12^th Grade)
  Emily Cloud 228-424-7292
- Receiving Confirmation? Yes No
- (If Yes, please attach a copy of your Baptismal certificate.)
- Director of Sacramental Preparation
  Brandy Kopszywa 228-860-4160
- ****PLEASE FILL OUT ALL PERTINENT INFO AS THESE FORMS WILL BE USED FOR UPCOMING SACRAMENTAL REGISTRATION AND CERTIFICATION. THANK YOU.****
- Last Name Please enter valid data.
- First Name Please enter valid data.
- Middle Name Please enter valid data.
- Age Maximum 5 characters Please enter valid data.
- Date of Birth Please enter valid data.
- Place of Birth Please enter valid data.
- Grade Please enter valid data.
- School Please enter valid data.
- Name to appear on Sacramental Certificate (include middle name): Please enter valid data.
- Father's Name (include middle name) Please enter valid data.
- Father's Religion Please enter valid data.
- Mother's Name (include middle name) Please enter valid data.
- Mother's Religion Please enter valid data.
- Street Address Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Phone Number Please enter valid data.
- Cell Number Please enter valid data.
- Emergency Contact and Number Please enter valid data.
- Email Address Please enter valid data.
- Please complete all that apply:
- Baptism
  
  Baptism Date: Maximum 25 characters Please enter valid data.
  
  Church of Baptism with complete mailing address:
  
  Priest who officiated Baptism: Please enter valid data.
  
  Sponsors (Godparents) (including middle names)
- Reconciliation
  
  Reconciliation Date: Please enter valid data.
  
  Church of Reconciliation with complete mailing address
- First Communion
  
  First Communion Date Please enter valid data.
  
  Church of First Communion with complete mailing address
- (If you have not received the Sacrament of Confirmation, some of the following information will be filled out at a later date.)
- Confirmation
  
  Confirmation Date Please enter valid data.
  
  Church of Confirmation with complete mailing address
  
  Name of Sponsor (to be filled in later if not confirmed) Please enter valid data.
  
  Bishop Officiating Please enter valid data.
  
  Name chosen for Confirmation (to be filled in later of not yet Confirmed) Please enter valid data.
  
  (There will be an additional future fee for Confirmation of $75.00 for retreat and materials.)
  
  Has your child received the Child Protection Curriculum by the Diocese of Biloxi? Yes No
  
  If you answer Yes.....
  
  Date Please enter valid data.
  
  Where Please enter valid data.
- Medical Information
  
  Does your child have any medical issues (Diabetes, epilepsy, ADD, food allergies, etc.) or others issue that we need to be aware of in order to better help your child? If so, please explain:
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