2022/2023...Reconciliation/First Eucharist Registration Reconciliation/First Eucharist Registration Question Title * 1. Information about the child receiving Reconciliation/1st Eucharist: Name(1st, Middle, Last) Age: Date of Birth: Gender: Date of Baptism: Name of Baptismal Church: Place of Baptism (City, State, Zip Code): OK Question Title * 2. Parent Information: Father's Name(1st, Middle, Last): Religion: Mother's Name(1st, Middle, MAIDEN NAME): Religion: Address: City: State& Zip: Email Address: Work Phone: Home Phone: OK Question Title * 3. Registered at Church of St. Therese?(If not, please fill out and turn in a registration form to office or Dianne Bailey) Yes No OK Please provide a copy of Baptismal Certificate by January 1, 2023.Participation in workshops constitutes your permission for your photograph or likeness to be used on our church website or for publicity purposes. OK Question Title * 4. FOR OFFICE USE ONLY: Name of Priest/Deacon: Information recorded in 1st Eucharist Register: In Computer: OK DONE