2020-2021 Registration Form

Student: First and Last Name Please enter valid data.

Date of Birth Please enter valid data.

Sex: Male or Female Please enter valid data.

Last Level Completed in Religious Education Please enter valid data.

For all NEW and Grade 1 Students please fill out the information below:

Baptism No Yes

Church/ Date Please enter valid data.

First Penance (Reconciliation): No Yes

Church Please enter valid data.

First Eucharist: No Yes

Church Please enter valid data.

A copy of your childs Baptismal Certificate is needed if your child was not baptized here at OLQM. (you can email a copy to cgamache@olqmff.comcastbiz.net, postal mail or drop in the collection basket at Mass).

Family Information

Mother's Name First and Last Please enter valid data.

Mother's Maiden Name Please enter valid data.

Father's Name: First and Last Please enter valid data.

Legal Guardian: Name: First and Last Please enter valid data.

Does your child live with (please check below):

Both Parents Yes

Mother Yes

Father Yes

Other Yes

If other: Please list with whom. Please enter valid data.

Home Address of the Child Please enter valid data.

*** Correspondence will be sent to the home address of the child unless otherwise indicated.

Email address: Please enter valid data.

Home Phone Number: Please enter valid data.

Mother cell: Please enter valid data.

Father cell: Please enter valid data.

Are there any parental custody/visitation restrictions we should be aware of:

Restrictions: No Yes

Emergency Contact Person: Please enter valid data.

Phone: Please enter valid data.

olqmseekonk@comcast.net

Does your child have any physical, social or learning disability needs that we should be aware of? Please enter valid data.

** All information is kept confidential.

Does your child have any food or other allergies? Please enter valid data.

Registered Member(s) of Our Lady Queen of Martyrs:

Members(s) Yes No

OUR LADY QUEEN OF MARTYRS

SEEKONK

2020-2021 Registration Form

On-line Registration