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

_____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________ _____________________________ _______________________________________