Communion Registration Form | Mother of God Parish

Parent Information

Last Name:(Required)

Father’s Name(Required)

Mother’s Name:(Required)

Please Enter Address Below(Required)

Address Number and Street City State Zip Code

Email(Required)

Mother's Cell Phone(Required)

Father's Cell Phone

Emergency Contact Person:(Required)

Emergency Phone(Required)

How Many Children Will Be Attending(Required)

Child(ren) Information

Child 1 First Name(Required)

Child 1 - Date of Birth(Required)

Child 1 - Grade in September(Required)

PLEASE NOTE: When a Grade Has Reached Capacity, It Will No Longer Appear In The Drop Down List.

Child 2 First Name(Required)

Child 2 - Date of Birth(Required)

Child 2 - Grade in September(Required)

PLEASE NOTE: When a Grade Has Reached Capacity, It Will No Longer Appear In The Drop Down List.

Child 3 First Name(Required)

Child 3 - Date of Birth(Required)

Child 3 - Grade in September(Required)

PLEASE NOTE: When a Grade Has Reached Capacity, It Will No Longer Appear In The Drop Down List.

Does your child(ren) have a learning disability? If so please explain.

Does your child(ren) have any food allergy? If so, indicate child and type of alergy.

Touching Safety Program

Our parish will be presenting a Child Abuse Prevention Program called the “Touching Safety Program” to all the children and youth enrolled in our parish programs. It is provided by St. Thomas Chaldean Diocese and is a part of our ongoing effort to help create and maintain a safe environment for children and to protect all children from sexual abuse. This educational program is mandated by the Conference of Catholic Bishops. As a parent you have a right to choose whether your child participates. If you have any question about the program you may contact your pastor.

Touching Safety Program (Similar to Protecting God's Children)(Required)

(YES) I give my permission to have my child participate in this safety program

(NO) I decline to have my child participate in this safety program

Do you permit Mother of God Chaldean Catholic Church to photograph and/or record your child during church programs and events and use these photos and videos on our website, social media, bulletin, and other church publications?(Required)

Yes

Baptism Certificate Upload

Please upload your child's baptism certificate here.

Max. file size: 256 MB.

Baptism Certificate Upload - Child 2

Please upload your child's baptism certificate here.

Max. file size: 256 MB.

Baptism Certificate Upload - Child 3

Please upload your child's baptism certificate here.

Max. file size: 256 MB.

Birth Certificate Upload(Required)

Please upload your child's baptism certificate here. This is required

Max. file size: 256 MB.

Birth Certificate Upload - Child 2(Required)

Please upload your child's baptism certificate here. This is required

Max. file size: 256 MB.

Birth Certificate Upload - Child 3(Required)

Please upload your child's baptism certificate here. This is required

Max. file size: 256 MB.

Credit Card Payment

Total

Credit Card(Required)

American Express

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MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name