REP Registration

Home
- About Us
- Our Staff
- Contact Us
- Email Blasts
- Our Patron
- Our History
- Calendar
- I'm New Here
- Readings
Reserve a Room
New Parishioner Registration
Bulletin
- Bulletins Archive
- Our Sponsors
Sacraments
Ministries
Organizations
School
Prayer Requests
Religious Ed

REP Registration

REP Registration

REP Registration

Childs Name

Address

City

State

ZIP Code

Birth Date

Baptism Date and Church

1st Communion Date and Church

Name and Grade of RE Program Last Year

School Child Attends

Grade in September

Any Special Needs

Fathers Name

Occupation

Religion

Phone Number

Phone

Cell Phone

Land Line

Email Address

Mothers Name

Occupation

Religion

Phone Number

Phone

Cell Phone

Land Line

E-Mail Address

Home Parish

Family Contact List

I consent to the above information distributed to REP families (via family contact list)

I do not consent to the above information to be included in the REP family contact list

Parental Status

Married

Seperated

Divorced

Father Deceased

Mother Deceased

Father Remarried

Mother Remarried

Child lives with...

Free Text

Emergency Contact

Contact Name

Contact Phone

Relationship to child

Free Text

ACADEMIC and HEALTH INFORMATION

Are there any concerns/conditions related to your child’s academic abilities or health limitations that your child’s teacher will need to know.

Yes

No

List concerns/conditions

Does he/she have an IEP? It helps us to plan for classroom aides and materials that will make your child’s experience better

Yes

No

Would you like to schedule a conference with the teacher before classes begin?

Yes

No

Does your child have any allergies that we should be aware of? List them here

Thank you for contacting us.
We will get back to you as soon as possible

Oops, there was an error sending your message.
Please try again later

Our Location

2445 W. 112th Street
Chicago, IL 60655

Contact Us

Connect with us

© 2026

WeConnect | By LPi

Share by: