Rite of Christian Initiation for Adults (RCIA) Today’s date______________

Adapted for Children Registration Form for Children

Last Name_________________________________ First Name________________________________

Middle Name____________ Nickname (if student wishes to use this name)___________________________

Address___________________________________________________________Apartment__________

City____________________________ State__________ Zip__________

Email ___________________________________________________________________________

Date of Birth___________________________________________Age_______________

Country of birth_________________________State____________City_______________________

Father’s Full Name_________________________________________________________________

Mother’s Full Maiden Name__________________________________________________________

Who does student live with? __________________________________________________________

Parent’s address (if different from above) ________________________________________________

Home Phone___________________ Cell (mother)_______________Cell (father)___________________

School________________________________________________Grade_____________

Emergency contact_____________________________________Phone_________________________

Sibling(s)

Name_______________________________ Age___________________ Name_______________________________ Age___________________ Name_______________________________ Age___________________ Name_______________________________ Age___________________

What is the family’s religious background? _____________________________________________ ________________________________________________________________________________

Comments _______________________________________________________________________ ________________________________________________________________________________

This form is for all children/teens who are 7 years or older who have not been baptized.  Complete it and mail it the office.  Sr. Yolanda Nunez, RMI 310 N Olive Ave. WPB 33401 – Include a $15 fee for materials.

Thanks!