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St. Mary Catholic Church
Biloxi, MS
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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
The maximum number of form submissions has been reached. This form is currently not available.
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
AK
AL
AR
AS
AZ
CA
CO
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DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MS
MT
NC
ND
NE
NH
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NM
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OK
OR
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RI
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TN
TX
UT
VA
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VT
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WI
WV
WY
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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