SMA 1st Reconciliation and 1st Communion Registration

INSTRUCTIONS

REGISTRATION — 2022-2023

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* 1. Please provide the following information below:

Child First Name

Child Middle Name

Child Last Name

Date of Birth

Place of Birth (City/State)

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* 2. Contact Information

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address:

Home Phone Number:

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* 3. Cell Phone Number

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* 4. Date of Baptism:

Date

Date

25% of survey complete.