Sacramental Preparation Registration 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* Enter Email Confirm Email Please provide an email address that your family checks REGULARLY, as this is our primary means of communication.Secondary Email Enter Email Confirm Email If you would like to add another email address to our regular communications list, please provide it above.Children ParticipatingFirst NameLast NameGenderGrade (2018-19 School Year)SacramentFirst Choice of DaySecond Choice of DayPlease describe any individual learning needs to best serve your family. (N/A if none) MaleFemale2567Reconciliation/CommunionConfirmationMondayTuesdayWednesdayMondayTuesdayWednesday 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 classes meet Monday, Tuesday, OR Wednesday from 4:30 pm - 5:30 pm in the Religious Education Building.Are you registered members of St. Pius X Parish?*Yes, my household is registered at St. Pius X.No, but we will submit the required parishioner registration form.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.Permission to Photograph* I agree to the statement below **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.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*Registration FeeOne Child - $185 Two Children - $295 Three Children - $390 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.Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle Ajax powered Gravity Forms.