• First Communion Class (2nd Grade) Registration Form

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  • Student's Full Name (First, Middle, Last) REQUIRED Please fill out this field. Please enter valid data.
  • Student's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  • Student's Church of Baptism (If not Immaculate Heart of Mary a Baptism Certificate will be needed) REQUIRED Please fill out this field. Please enter valid data.
  • Current Grade REQUIRED Please fill out this field. Please enter valid data.
  • Father's Full Name (First, Middle, Last) REQUIRED Please fill out this field. Please enter valid data.
  • Father's Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  • Father's Email Address REQUIRED Please fill out this field. Please enter valid data.
  • Mother's Full Name (First, Middle, Madien, Last) REQUIRED Please fill out this field. Please enter valid data.
  • Mother's Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  • Mother's Email Address REQUIRED Please fill out this field. Please enter valid data.
  • Street Address REQUIRED Please fill out this field. Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT 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 NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • First Communion Class Fee30.0

  • • By checking below, I agree to the following:

      • I give my permission to Immaculate Heart of Mary Church to send text messages to my cell phone.
      • I give my permission to Immaculate Heart of Mary Church to take pictures of my child(ren) on various occasions throughout the year for social media, Church Today and the Immaculate Heart of Mary website.

    I Agree Please select this field.

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