Religious Education Registration Form

Parish Status REQUIRED I am a registered Parishioner at Beatitudes of Our Lord Please register me with this Parish and Faith Formation Please register me for Religious Education ONLY Please fill out this field.

Has Child received the Sacrament of Baptism REQUIRED YES NO Please fill out this field.

Has Child made his/her First Reconciliation REQUIRED YES NO Please fill out this field.

Has Child made his/her First Communion REQUIRED YES NO Please fill out this field.

Child lives with: REQUIRED Mother Father Both Other Please fill out this field.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

FATHER'S INFORMATION

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Father's Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Father's Employer REQUIRED Please fill out this field. Please enter valid data.

Father's Occupation REQUIRED Please fill out this field. Please enter valid data.

Father's Work Phone Please enter valid data.

Father's Email REQUIRED Please fill out this field. Please enter valid data.

Please provide father's address if different than above, otherwise leave blank Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Are you Catholic? REQUIRED YES NO Please fill out this field.

Church of Marriage Please enter valid data.

Are you Virtus Certified REQUIRED YES NO Please fill out this field.

MOTHER'S INFORMATION

Mother's Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Mother's Employer REQUIRED Please fill out this field. Please enter valid data.

Mother's Occupation REQUIRED Please fill out this field. Please enter valid data.

Mother's Work Phone Please enter valid data.

Mother's Email REQUIRED Please fill out this field. Please enter valid data.

Please provide mother's address if different than above, otherwise leave blank Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Are you Catholic? REQUIRED YES NO Please fill out this field.

Church of Marriage Please enter valid data.

Are you Virtus Certified REQUIRED YES NO Please fill out this field.

Child's Name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Church of Baptism Please enter valid data.

Date Please enter a date.

School Name and Grade (As of August 2025) REQUIRED Please fill out this field. Please enter valid data.

Year of Formation REQUIRED 1st Year "Family Preparation" 2nd Year "First Reconciliation" 3rd Year "Holy Communion" 1st Year Confirmation 2nd Year Confirmation Please fill out this field.

There is no need to complete multiple registration forms for each child. Simply add your children's details below. Please indicate if they are in our Faith Formation Program and specify the year, or if they are in our Confirmation Program and include the year.

2nd Child's Name Please enter valid data.

Date of Birth Please enter valid data.

School Name and Grade (As of August 2025) Please enter valid data.

Church of Baptism Please enter valid data.

Date Please enter a date.

Year of Formation 1st Year "Family Preparation" 2nd Year "First Reconciliation" 3rd Year "Holy Communion" 1st Year Confirmation 2nd Year Confirmation

3nd Child's Name Please enter valid data.

Date of Birth Please enter valid data.

School Name and Grade (As of August 2025) Please enter valid data.

Church of Baptism Please enter valid data.

Date Please enter a date.

Year of Formation 1st Year "Family Preparation" 2nd Year "First Reconciliation" 3rd Year "Holy Communion" 1st Year Confirmation 2nd Year Confirmation

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

Relationship REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Please answer the following questions in order to insure a safe and productive learning environment:

Do any of your children have a medical condition and/or severe allergy that we should know about? Please list below REQUIRED Please fill out this field. Please enter valid data.

Please let us know if your child has been diagnosed with any of the following: ADD ADHD ASD Down Syndrome OTHER

OTHER: Please enter valid data.

Does your child require any of the following services (Check all appropriate) Vision Services ESL Hearing Services Other

OTHER: Please enter valid data.

Does your child have any other concerns? REQUIRED Please fill out this field. Please enter valid data.

Are there any special family situations that we need to be made aware of? If yes, explain. REQUIRED Please fill out this field. Please enter valid data.

By clicking agree below, I give permission for my child/children/youth to participate in this faith formation program, whether conducted onsite or online.

I Agree Please select this field.

Are there any adult family members who want or need Baptism, Confirmation, or Holy Communion? If yes, and they wish to be called regarding joining RCIA, please provide their information below. Please enter valid data.

Phone Number Please enter a phone number.

Please provide an email address where you would like to receive further instructions on uploading the baptism document and other required consent forms. These will be sent to you after this form is submitted. REQUIRED Please fill out this field. Please enter an email address.

Beatitudes of Our Lord Church

La Mirada, CA

Religious Education Registration Form