MARY, MOTHER OF MANKIND CHURCH
FAITH FORMATION REGISTRATION FORM
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MARY MOTHER OF MANKIND CHURCH
25, 4th Street, North providence, RI 02911, Ph. 401-231-3542
Religious Education Registration Form
PLEASE PRINT CLEARLY AND FILL IN ALL REQUESTED INFORMATION
STUDENT’S FULL NAME: _____________________________________________________________________
LAST FIRST MIDDLE IN FULL
PRESENT AGE: ______ GENDER: M__ F___ BIRTHDATE:____/____/______ Home Phone #____________________
M /D/YEAR
___________________________________________________________________________________________________________________
Street City State Zip Code
CHECK THE LEVEL YOU WISH TO ENROLL YOUR CHILD:
_____Pre-Communion _____FIRST COMMUNION*
*To enroll your child in the First Communion Program, he/she must have completed Level 1 (Pre-Communion). Also, attach to this completed form, a copy of your child’s Baptismal Certificate.
If your child is not baptized, please see our Pastor, Rev. TJ Varghese.
_____Level 3 _____Level 4 _____Level 5 _____Level 6
_____Pre-Confirmation _____CONFIRMATION**
**To enroll your child in the Confirmation Program, he/she must have completed Pre-Confirmation. Also, attached to this completed form, a copy of your child’s Baptismal and First Communion Certificate. If your child has not received one or both sacraments, please see Fr. TJ Varghese
There will also be a separate sacramental fee for First Communion & Confirmation.
Family Data: (PLACE A √ IN THE BOXES BELOW IF THE INFORMATION IS THE SAME AS THE STUDENT’S ABOVE.)
__________________________________________________ ______________________________________________________
Mother’s Name/Legal Guardian (Mrs., Ms., Miss) Father’s Name/Legal Guardian Title (Mr.)
Street ______________________________________________________________________________________
City, St., Zip ________________________________________________________________________________
Home Phone#______________________________________________________________________________
Cell Phone#________________________________________________________________________________
E-Mail ______________________________________________________________________________________
Maiden Name _____________________________________________________________________________
If applicant is not living with both parents, to whom and at what address should mail be sent. (No P.O. BOXES)
___MOTHER ___FATHER
ADDRESS: _____________________________________ __________________________________________________________________________________________________________________
NUMBER AND STREET CITY STATE ZIP CODE
Location & Times of Classes ~ all classes will take place in the parish Hall
- Levels 1-6 will meet Sundays from 9:00AM to 10:00AM.
- Levels 7-10 will meet Sundays from 11:15pm SHARP – 12:15PM.
- Students in the Religious Education Program are required to attend Mass weekly.
- If a student attends another church, he/she needs to bring a signed bulletin to his/her next class.
Registration Fees ~ The registration fee for the 2022-2023 school year is $40.00 per student, not to exceed $75.00 per family. Please make checks payable to Mary Mother of Mankind Church and attach it to this completed form(s). This fee is for the purchase of books and materials needed in educating your child. If you are unable to meet this fee because of genuine hardship, please talk to Fr. TJ Varghese. This will not be a barrier to enrolling your child in religious education.
IN CASE OF AN EMERGENCY, IF WE ARE UNABLE TO CONTACT YOU, WHOM SHOULD WE CONTACT?
NAME____________________________________________________________________________________
RELATION TO STUDENT_________________________ Cell__________________________
Please list all the adults (including parents) authorized to pick up your child. Your child will not be released to any other adult who is not listed below:
_________________________________________________________________________________________________________________
Emergency Name#1 Relationship
Phone #________________________ Cell#_________________________
_____________________________________________ __________________________________
Emergency Name#2 Relationship
Phone #______________________________ Cell#_________________________
_______________________________________________________________________________________________
Emergency Name#3 Relationship
Phone #________________________ Cell#_________________________
STUDENT MEDICAL INFORMATION Allergies___________________________________________________________________________________________
Physical Disabilities: _________________________________________________________________________________
Learning Disabilities: ________________________________________________________________________________
~ Photo Image Consent Form ~
I, the undersigned, do hereby give permission or not to Mary mother of Mankind Parish and the Religious Education Program to use, publish, display, and/or reproduce any video/recorded voice/digital media, photographs of my son/daughter in promotional materials for Mary mother of Mankind Parish and the Religious Education Program. (Please circle one)
I/we DO give permission for_________________________ or DO NOT give permission for_______________________
Child’s full name Child’s full name
to use an image/photograph/video clip/voice as described above. We are willing to release this into the public domain for promotional purposes and understand that no monetary compensation will be given for its use.
Parent/Guardian _________________________________________ Parent/Guardian _________________________________
Print Name Signature
Date___________
Special Note: All students participating in the Religious Education Program must provide a copy of the certificates of the
sacraments they have received thus far if you have not yet done so.
FOR OFFICE USE ONLY
BAPTISMAL RECORD YES ( ) NO ( ) DATE__________
1st PENANCE YES ( ) NO ( ) DATE__________ 1st COMMUNION RECORD YES ( ) NO ( ) DATE__________ REGISTRATION FEE YES ( ) NO ( ) FEES W/____________/____
AMOUNT PAID___________ CK. #__________ CASH __________ RECD. BY ______ DATE_________