FF Reg

Family and Enroll Student Registration Form

Welcome to our St. Bernadette Catholic Church. Visit our web site at www.stbnc.net for more
 information.

Click Submit Form to send this information to St. Bernadette Catholic Church.

*Required fields

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Family Options  New Family  Update Existing Family  – ID/Env 
Head of Household
Title *First Name *Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity   Birth Date *Gender Female   Male
Grade/Degree   Language Marital Status
Phone Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  Phone 1 ( ) – Unlisted
  Email 1   Unlisted
Send Email Instead of Mail When Possible
Spouse
  First Name   Last Name Suffix
Relationship   Middle Name   Nickname
  Birth Date   Gender Female   Male
Grade/Degree   Language Marital Status
Phone Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  Phone 1 ( ) – Unlisted
  Email 1   Unlisted
Send Email Instead of Mail When Possible
Family Street Address
*Line 1
  Line 2
*City
*State
*ZIP
Family Phone Numbers
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
*Primary ( ) – Unlisted
  Other ( ) – Unlisted
Family Email Address
*Email   Unlisted
Send Email Instead of Mail When Possible
Family Remarks
  Remarks
Student 1   Type  
Title *First Name *Last Name Suffix
Relationship   Middle Name   Nickname Maiden Name
Ethnicity   Birth Date *Gender Female   Male
Grade/Degree   Language Marital Status
Phone Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  Phone 1 ( ) – Unlisted
  Email 1   Unlisted
Send Email Instead of Mail When Possible
Sacraments   Name Received Date Place
   Baptism
   Confirm
   Penance
   First Comm
Ministries   Name Interested in Joining
  
  
Talents   Name Interested in Joining
  
*Class Choices
*Class 1
Student Remarks
  General Remarks
  Health Problems
  Other Conditions
  Misc. Information
Student Contact 1
  First Name   Last Name Suffix
  Relationship  &nbspMarital Status
Address
  Line 1
  Line 2
  City
  State
  ZIP
Phone Numbers
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  Primary ( ) – Unlisted
  Other ( ) – Unlisted
Email Address
  Email
Send Email Instead of Mail When Possible
Student Contact 2
  First Name   Last Name Suffix
Address
  Line 1
  Line 2
  City
  State
  ZIP
Phone Numbers
Note: If you would like to receive a text message when your parish sends a quick communication,
select your provider from the Description drop-down list. Standard text messaging rates apply.
  Primary ( ) – Unlisted
  Other ( ) – Unlisted
Email Address
  Email
Send Email Instead of Mail When Possible

Click Submit Form to send this information to St. Bernadette Catholic Church.

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