Office Use Only: S1
S2
Bapt Cert
Inv. #_____________ Date Rec’d____________ W
1st Comm
Birth Cert
Igniter
ToB
RCIT
Release
PiF
OUR LADY OF THE VALLEY –PARROQUÍA DE NUESTRA SEÑORA DEL VALLE
Family Ministry Registration – Inscripción para el Ministerio Familiar Youth Information / Información del Jóven Last Name of Child/Youth ______________________________ First Name_______________________ MI _________ Apellido del/a jóven/niño/a Primer nombre Segundo nombre Date of Birth ____/____/____ Fecha de nacimiento
Grade in 2019/20 (circle one): 1 2 3 4 5 6 7 8 9 10 11 12 Grado en la escuela en 2019/20
Mailing Address: __________________________________________________________________________________ Dirección City__________________________ Ciudad
State___________ Estado
Zip Code____________ Código postal
Home Phone: (____) ____ - ______ Youth Cell: (____) ____ - _____ Youth Email:____________________________ Número de teléfono de casa Número del/a jóven Correo electrónico del/a jóven Allergies / Alergias _______________________________________________________________________________
Parent Information / Información de los Padres Mother’s Name: ___________________________________________________________________________________ Nombre de la Madre Mother’s Phone: (____) ____ - ______ Número de la Madre
Mother’s Email: _____________________________________________ Correo electrónico de la Madre
Father’s Name: ___________________________________________________________________________________ Nombre del Padre Father’s Phone: (____) ____ - ______ Número del Padre
Father’s Email: _____________________________________________ Correo electrónico del Padre
Are parents married/living together? Están casados o viviendo juntos los padres del/a jóven? Yes/Sí
Sacraments you want your youth to receive this year? Circle: Baptism
No
First Communion
Confirmation
Por favor marque el sacramento que usted quiere que su hijo/a reciba este año: Baustimo Primera Comunión Confirmación ____________________________________________________________________________
If you marked any sacraments above, please complete the information below Si ha marcado alguno de los sacramentos, por favor complete lo siguiente Baptism / Bautismo: Has the youth been baptized?/ ¿El/a jóven esta bautizado? Yes/Sí ____ No____ If yes, Church Name/Si lo ha recibido, nombre de la Iglesia: _________________________Date/Fecha: ___/___/_____ Church Address / Dirección de la Iglesia:_______________________________________________________________ City:___________________________________ State:_____ Ciudad Estado
Zip Code:_____________ Country:________________ Código postal País
First Communion / Primera Comunión: Has the youth rec’d First Communion? /¿El/a joven ha recibido la Primera Comunión? Yes/Sí No If yes, Church Name/ Si lo ha recibido, nombre de la Iglesia: _________________________Date/Fecha: ___/___/_____ Church Address / Dirección de la Iglesia:________________________________________________________________ City:___________________________________ State:_____ Ciudad Estado
Zip Code:_____________ Country:________________ Código postal País
Office Use Only: Individual $40 or Family $80
2018-19 Inv#_________
$__________
No Sacrament Registration after 09/29/2019 First Communion (1st-5th) = $25 x ____ First Communion (6th-9th) = $80 x ____ First Comm &/or Confirmation (10th-12th) = $160 x ____
___________ ___________ ___________
Total Amount Due $___________ Check#_______ Cash__ CC Ref# ______ $____.___ Rec’d by:______ Rcpt #___________ Date:________ Check#_______ Cash__ CC Ref# ______ $____.___ Rec’d by:______ Rcpt #___________ Date:________ Check#_______ Cash__ CC Ref# ______ $____.___ Rec’d by:______ Rcpt #___________ Date:________ Check#_______ Cash__ CC Ref# ______ $____.___ Rec’d by:______ Rcpt #___________ Date:________ Check#_______ Cash__ CC Ref# ______ $____.___ Rec’d by:______ Rcpt #___________ Date:________ Notes: Forms & Requirements:
Registration/Health Received Sponsor Contract Received Circle of Grace Received Retreats Attended ________ Payment in Full Received
Letter to Bishop Received (Confirmation) Saint Name Received (Confirmation) Service Hours Complete Parent Meetings Attended __________ Absences for Year ___________
Names of other children in Family Ministry First Name/Nombre
Last Name/Apellido
_____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________