FIRST RECONCILIATION &amp;&lt;div&gt;Eucharist REGISTRATION&lt;/div&gt;

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Middle Name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

City of Birth REQUIRED Please fill out this field. Please enter valid data.

State of Birth

Date of Baptism REQUIRED Please fill out this field. Please enter a date.

Place of Baptism (Church Name) REQUIRED Please fill out this field. Please enter valid data.

Church Mailing Address REQUIRED Please fill out this field. Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Student Grade in Fall REQUIRED Please fill out this field.

School Attending in Fall REQUIRED Please fill out this field.

Faith Formation the Year Prior to Sacrament Preparation (last school year) REQUIRED Holy Family: Resurrection Holy Family: OLG Parish Program: School Year YFF Parish Program: School Year Homeschool YFF Parish Program: Summer YFF Parish Program: Summer Homeschool YFF None Please fill out this field.

Faith Formation the Year Preparing for the Sacrament (this school year) REQUIRED Holy Family: Resurrection Holy Family: OLG Parish Program: School Year YFF Parish Program: School Year Homeschool YFF Parish Program: Summer YFF Parish Program: Summer Homeschool YFF None Please fill out this field.

MEDIA RELEASE & AUTHORIZATION REQUIRED

I understand that by responding "Yes" I hereby grant authority to my child’s parish for the use of any videos, photos, or similar items to used in social media or on a parish web page.

YES NO Please fill out this field.

PARTICIPANT INFORMATION RELEASE REQUIRED

I understand that by responding "Yes" I hereby grant authority to my child’s parish for the publication of participant information in the parish directory and other parish publications.

YES NO Please fill out this field.

Church of the Resurrection

4300 Asbury Road, Dubuque, IA 52002
(563) 556-7511

FIRST RECONCILIATION &
Eucharist REGISTRATION

FIRST RECONCILIATION &Eucharist REGISTRATION

FIRST RECONCILIATION &
Eucharist REGISTRATION