Religious Education Enrollment Form: Holy Name of Jesus Religious Education First student InformationFirst and Last Name: *Date of Birth Grade: Date of Baptism: Church of Baptism: Check the Sacrament to Receive: *BaptismPenance / ReconciliationHoly Eucharist / First CommunionConfirmationStudent Need's Special Attention? YesNoPlease Describe: Second Student InformationFirst and Last Name: Date of Birth Grade: Date of Baptism: Church of Baptism: Check the Sacrament to Receive: BaptismPenance / ReconciliationEucharist / First CommunionConfirmationStudent Need's Special Attention? YesNoPlease Describe: Third Student Information:First and Last Name: Date of Birth Grade: Date of Baptism: Church of Baptism: Check the Sacrament to Receive: BaptismPenance / ReconciliationEucharist / First CommunionConfirmationStudent Need's Special Attention? YesNoPlease Descibe: Parent InformationFather's First and Last Name: Mother's First and Last Name: Home Address: *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryHome Phone Number: Cell Phone Number: Email Are you an active member of HNJ? *YesNoIf Yes Envelope Number Day and time you attend mass? *Please select8:15 am Tuesday or Friday6:00 pm Wednesday4:30 pm Saturday8:00 am Sunday9:45 am Sunday11:30 am Sunday Emergency Contact Information:First and Last Name: Phone Number: *Relationship: Registration Fee:Active Parishioners 1- Student $75.002- Student $150.003 Students or more $200.00Non-Members 1-Student $150.002-Student $300.003 or more-Student $400.00 VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
