2019/2020 Registration PLEASE READ ALL INFORMATION ON THE SACRAMENTAL PREPARATION HOME PAGE BEFORE COMPLETING THE REGISTRATION BELOW. Father's Name* Mr.Dr. Prefix First Last Mother's Name* Mrs.Ms.Dr. Prefix First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Please provide a cell phone number we may use to contact you via text message in the event of a cancellation or emergency.Relation to Student(s)*MotherFatherSecondary Cell PhoneThis cell phone number will receive the same updates regarding cancellations, emergencies, etc. via text message.Relation to Student(s)MotherFatherEmail*Please provide an email address that your family checks REGULARLY, as this is our primary means of communication. Enter Email Confirm Email Secondary EmailIf you would like to add another email address to our regular communications list, please provide it above. Enter Email Confirm Email Children ParticipatingClick the "+" to add multiple children in your family. Please list children registering for preparation to receive the sacraments of First Reconciliation/First Communion (2nd grade or above) OR Confirmation (5th grade or above) ONLY. All registrations must include a second choice that is DIFFERENT from their first choice - choosing the same day twice does not guarantee placement on that day! All classes meet Monday, Tuesday, OR Wednesday from 4:30 pm - 5:30 pm in the Religious Education Building. First NameLast NameGenderGrade (2019/20)SacramentFirst Choice of DaySecond Choice of DayPlease describe any individual learning needs to best serve your family. (N/A if none) MaleFemale2567Reconciliation/CommunionConfirmationMondayTuesdayWednesdayMondayTuesdayWednesday Are you registered members of St. Pius X Parish?*Participation in Sacramental Preparation at St. Pius X requires that each household is registered with the parish. Registration will not be processed without pre-existing parishioner registration.Yes, my household is registered at St. Pius X.No, but we will submit the required parishioner registration form.Permission to Photograph***St. Pius X staff may use pictures containing families, including minors, for the sole purpose of promoting our program here at St. Pius X in the weekly bulletin, parish website, newsletters or articles that may appear in the Fairfield County Catholic (the Diocesan newspaper). News Releases will never contain last names of any minors. Addresses and phone numbers will never be released in such publications. This agreement will be considered active and ongoing unless it is cancelled, in writing, by the individual or their parent/guardian. I give permission for St. Pius X staff to photograph members of my family. These photos can be used in the above-named news releases from this day forward unless this agreement is cancelled per my request. I agree to the statement above Parent Sessions (E-Signature Required)*I understand that as the parent of a child preparing to receive a sacrament, I am required to attend five (5) parent sessions. I will attend all of these sessions throughout the year in order to best prepare my son/daughter to receive the graces of these sacraments.Number of ChildrenRegistration Fee*One Child - $200 Two Children - $350 Three Children - $500 I agree to pay the stated registration fee for my child(ren). I understand that registration will not be processed until payment has been received in full. If you have financial concerns or a credit card payment is not possible, please contact our office at 203-259-4800.Registration FeeTotal $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle Ajax powered Gravity Forms.