OLPH Little Church Registration Form 2008 - 2009

Please print all information in the spaces provided. Date: __________

Child’s Date of Birth: ____/____/____ Class Age: 3’s 4’s 5’s

Child’s Name: ___________________________________ Sex: M or F

Home Address: __________________________________________________

City: ________________________ Zip: _____________

Home Phone: ______________ Cell: _____________

E-Mail Address: ___________________________________

Father’s (Guardian) Name: _____________________ Catholic ?: Y or N

Mother’s (Guardian) Name: ____________________ Catholic ?: Y or N

Parent Participation: I agree to assist with Two of the following:

Regularly Regularly

Teach 3 year olds: ________________ Aide 3 year olds: ________________

Teach 4 year olds: ________________ Aide 4 year olds: ________________

Teach 5 year olds: ________________ Aide 5 year olds: ________________

Substitute teach: _____ Holiday Program: ________ Bake Sale: ___________

Assist with Little Church BBQ Booth: ____________

Special Talents: _____________________________________________________

* PARENT SIGNATURE: ___________________________________________

For Office Use Only

Proof of the following must be given to complete registration

Baptismal Certificate (copy): Y or N

Parish I.D. #: _________

Registration Fee Paid ($65.00): Y or N Check No. ______ Cash: _____

Registrar’s Initials: __________