.COM/JR Registration | Mother of God Parish

.COM/JR Registration Form 2023

"*" indicates required fields

Parent Information

Last Name:*

Father’s Name*

Mother’s Name:*

Please Enter Address Below*

Address Number and Street City State Zip Code

Email*

Home Phone

Father's Cell Phone

Mother's Cell Phone

Emergency Contact Person:*

Emergency Phone

How Many Children Will Be Attending

Child(ren) Information

Child 1 First Name*

Child 1 - Date of Birth*

Child 1 - Grade in September*

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

Child 2 First Name*

Child 2 - Date of Birth*

Child 2 - Grade in September*

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

Child 3 First Name*

Child 3 - Date of Birth*

Child 3 - Grade in September*

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

Child 4 First Name

First

Child 4 - Date of Birth

Child 4 - Grade in September*

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

Child 5 First Name

First

Child 5 - Date of Birth

Child 5 - Grade in September*

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)*

(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