Form's Instructions
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Grades K-8
Stephanie Conrad
Director of Religious Education
717-243-4411 X300
sconrad@saintpatrickchurch.org
Head of Household
Title
None
Mr.
Ms.
Mrs.
Miss
Dr.
* First Name
* Last Name
Suffix
None
Sr.
Jr.
II
III
IV
V
VI
VII
VIII
XV
X
Relationship
ADOPTED
CHILD
DAUGHTER
FATHER
FIANCE
FOSTER FATHER
FOSTER MOTHER
GRANDCHILD
GRANDDAUGHTER
GRANDFATHER
GRANDMOTHER
GRANDSON
GUARDIAN
Head-Female
Head-Male
HUSBAND
MOTHER
OTHER
SON
SPOUSE
STEP FATHER
STEP MOTHER
STEPCHILD
Middle Name
Nickname
Maiden Name
Birth Date
* Gender
Male
Female
Language
Latin
Spanish
Marital Status
CIVIL CEREMONY
Civil-blessed-Catholic Church
DECEASED
DIVORCED
DIVORCED - ANNULMENT
FIANCE
MARRIED
NOT MARRIED
SEPARATED
SINGLE
WIDOW
WIDOWER
Email 1
HOME
WORK
Unlisted
Email 2
HOME
WORK
Unlisted
Spouse
Title
None
Mr.
Ms.
Mrs.
Miss
Dr.
First Name
Last Name
Suffix
None
Sr.
Jr.
II
III
IV
V
VI
VII
VIII
XV
X
Relationship
ADOPTED
CHILD
DAUGHTER
FATHER
FIANCE
FOSTER FATHER
FOSTER MOTHER
GRANDCHILD
GRANDDAUGHTER
GRANDFATHER
GRANDMOTHER
GRANDSON
GUARDIAN
Head-Female
Head-Male
HUSBAND
MOTHER
OTHER
SON
SPOUSE
STEP FATHER
STEP MOTHER
STEPCHILD
Middle Name
Nickname
Maiden Name
Birth Date
Gender
Male
Female
Language
Latin
Spanish
Marital Status
CIVIL CEREMONY
Civil-blessed-Catholic Church
DECEASED
DIVORCED
DIVORCED - ANNULMENT
FIANCE
MARRIED
NOT MARRIED
SEPARATED
SINGLE
WIDOW
WIDOWER
Email 1
HOME
WORK
Unlisted
Family Street Address
* Line 1
Line 2
* City
* State
Alabama (AL)
Alaska (AK)
American Samoa (AS)
Arizona (AZ)
Arkansas (AR)
California (CA)
Colorado (CO)
Connecticut (CT)
Delaware (DE)
District of Columbia (DC)
Federated States of Micronesia (FM)
Florida (FL)
Georgia (GA)
Guam (GU)
Hawaii (HI)
Idaho (ID)
Illinois (IL)
Indiana (IN)
Iowa (IA)
Kansas (KS)
Kentucky (KY)
Louisiana (LA)
Maine (ME)
Marshall Islands (MH)
Maryland (MD)
Massachusetts (MA)
Michigan (MI)
Minnesota (MN)
Mississippi (MS)
Missouri (MO)
Montana (MT)
Nebraska (NE)
Nevada (NV)
New Hampshire (NH)
New Jersey (NJ)
New Mexico (NM)
New York (NY)
North Carolina (NC)
North Dakota (ND)
Northern Mariana Islands (NP)
Ohio (OH)
Oklahoma (OK)
Oregon (OR)
Palau (PW)
Pennsylvania (PA)
Puerto Rico (PR)
Rhode Island (RI)
South Carolina (SC)
South Dakota (SD)
Tennessee (TN)
Texas (TX)
Utah (UT)
Vermont (VT)
Virgin Islands (VI)
Virginia (VA)
Washington (WA)
West Virginia (WV)
Wisconsin (WI)
Wyoming (WY)
Alberta (AB)
British Columbia (BC)
Manitoba (MB)
New Brunswick (NB)
Newfoundland and Labrador (NL)
Northwest Territories (NT)
Nova Scotia (NS)
Nunavut (NU)
Prince Edward Island (PE)
Saskatchewan (SK)
Ontario (ON)
Quebec (QC)
Yukon (YT)
Other
* ZIP
Family Phone Numbers
Note: If you would like to receive a text message when your parish sends a quick communication, select your provider from the Description drop-down list. Standard text messaging rates apply.
* Primary
CELLULAR Dad
CELLULAR Mom
EMERGENCY
HOME PHONE
Text-Alltel
Text-AT&T
Text-Boost
Text-BoostMobile
Text-Cingular
Text-MetroPCS
Text-Nextel
Text-Revol
Text-Sprint
Text-Straight Talk
Text-SunCom
Text-T-Mobile
Text-TractPhone
Text-US Cellular
Text-Verizon
WORK
( )
-
Unlisted
Other
CELLULAR Dad
CELLULAR Mom
EMERGENCY
HOME PHONE
Text-Alltel
Text-AT&T
Text-Boost
Text-BoostMobile
Text-Cingular
Text-MetroPCS
Text-Nextel
Text-Revol
Text-Sprint
Text-Straight Talk
Text-SunCom
Text-T-Mobile
Text-TractPhone
Text-US Cellular
Text-Verizon
WORK
( )
-
Unlisted
Family Email Address
* Email
HOME
WORK
Unlisted
Fee Total = $0.00
Student 1
Type
Head of Household
Spouse
Adult
Young Adult
Child
Other
* First Name
* Last Name
Relationship
ADOPTED
CHILD
DAUGHTER
FATHER
FIANCE
FOSTER FATHER
FOSTER MOTHER
GRANDCHILD
GRANDDAUGHTER
GRANDFATHER
GRANDMOTHER
GRANDSON
GUARDIAN
Head-Female
Head-Male
HUSBAND
MOTHER
OTHER
SON
SPOUSE
STEP FATHER
STEP MOTHER
STEPCHILD
Middle Name
Nickname
* Birth Date
* Gender
Male
Female
* Grade/Degree
1
2
3
4
5
6
7
8
K
Language
Latin
Spanish
Sacraments
Name
Received
Date
Baptism
Yes
No
MM
01
02
03
04
05
06
07
08
09
10
11
12
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
2061
2062
2063
2064
2065
2066
2067
2068
2069
2070
2071
2072
2073
2074
2075
2076
2077
2078
2079
2080
2081
2082
2083
2084
2085
2086
2087
2088
2089
2090
2091
2092
2093
2094
2095
2096
2097
2098
2099
2100
2101
2102
2103
2104
2105
2106
2107
2108
2109
2110
2111
2112
2113
2114
2115
2116
2117
2118
2119
2120
2121
2122
2123
2124
2125
2126
2127
2128
2129
2130
2131
2132
2133
2134
2135
2136
2137
2138
2139
2140
2141
2142
2143
1st Communion
Yes
No
MM
01
02
03
04
05
06
07
08
09
10
11
12
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
2061
2062
2063
2064
2065
2066
2067
2068
2069
2070
2071
2072
2073
2074
2075
2076
2077
2078
2079
2080
2081
2082
2083
2084
2085
2086
2087
2088
2089
2090
2091
2092
2093
2094
2095
2096
2097
2098
2099
2100
2101
2102
2103
2104
2105
2106
2107
2108
2109
2110
2111
2112
2113
2114
2115
2116
2117
2118
2119
2120
2121
2122
2123
2124
2125
2126
2127
2128
2129
2130
2131
2132
2133
2134
2135
2136
2137
2138
2139
2140
2141
2142
2143
Confirmation
Yes
No
MM
01
02
03
04
05
06
07
08
09
10
11
12
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
2061
2062
2063
2064
2065
2066
2067
2068
2069
2070
2071
2072
2073
2074
2075
2076
2077
2078
2079
2080
2081
2082
2083
2084
2085
2086
2087
2088
2089
2090
2091
2092
2093
2094
2095
2096
2097
2098
2099
2100
2101
2102
2103
2104
2105
2106
2107
2108
2109
2110
2111
2112
2113
2114
2115
2116
2117
2118
2119
2120
2121
2122
2123
2124
2125
2126
2127
2128
2129
2130
2131
2132
2133
2134
2135
2136
2137
2138
2139
2140
2141
2142
2143
Student Remarks
General Remarks