Sacrament Registration

Child / Teen INFORMATION

I am registering for: REQUIRED First COMMUNION and RECONCILIATION Preparation 3rd GRADE AND OLDER CONFIRMATION Preparation Please fill out this field.

Parishioner at Our Lady of Mercy REQUIRED Yes No Please fill out this field.

If no, please CLICK HERE to become a registered parishioner at Our Lady of Mercy.

Student First Name REQUIRED Please fill out this field. Please enter valid data.

Student Last Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Male or Female Male Female

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Name of School REQUIRED Please fill out this field. Please enter valid data.

SACRAMENTS

Church of Baptism REQUIRED Please fill out this field. Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Year of Baptism REQUIRED Please fill out this field. Please enter valid data.

Church of First Holy Communion (if already received) Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Year of First Holy Communion (if already received) Please enter valid data.

Church of First Reconciliation (if already received) Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

PRIOR RELIGIOUS INSTRUCTION Attended Catholic School

Name of School Please enter valid data.

OR Attended Religious Education

Name of Church Please enter valid data.

Religious Education Grades Completed REQUIRED

Please select all of the grades that your child attended Religious Education.

Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade Please fill out this field.

Baptismal Certificate and/or make-up work may be required.

PARENT INFORMATION
This information is needed because when a sacrament is received, we are required to notify the church of the recipient's Baptism so they may record it for their records.

Birth Mother's Maiden Name (As Appears on Baptismal Certificate) REQUIRED Please fill out this field. Please enter valid data.

Birth Father's Name (As Appears on Baptismal Certificate) REQUIRED Please fill out this field. Please enter valid data.

Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Preferred CELL Number REQUIRED Please fill out this field. Please enter a phone number.

This is the cell number for: REQUIRED Mother Father Please fill out this field.

Parent Preferred Email REQUIRED Please fill out this field. Please enter an email address.

EMERGENCY CONTACT INFORMATION

Emergency Contact Person REQUIRED Please fill out this field. Please enter valid data.

Relationship REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone # REQUIRED Please fill out this field. Please enter a phone number.

Please indicate below if there is anything we
should know about the Candidate to help make
the preparation experience more enjoyable and
meaningful?

-

Photo Release Permission Slip
As a parent or guardian of this student, I hereby consent to the use of photographs/video taken during the program for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.

Please select one REQUIRED Yes, I give consent for Our Lady of Mercy to photograph/video my child during the program and/or events for promotional purposes Pictures will never be posted on the internet. No, I do not authorize Our Lady of Mercy to photograph/video my child during the program and/or events. Please fill out this field.

Payment and Next Steps

Upon submission of this form you will be directed to the Parish Giving Website to pay the sacrament fee of $175. Your registration will not be processed until payment is received. If you are in need of financial assistance, please contact our office. We are happy to help.

Our Lady of Mercy

2 FREMONT AVENUE
PARK RIDGE, NJ 07656

Sacrament Registration

Fill out the form below to register for
First Communion
only if you:
Are older than 2nd grade
are aN OLMA student

or for Confirmation preparation for
grades 9 and up

There is a sacrament fee of $175

Upon submission of this form you will be directed to the Parish Giving Website to pay the sacrament fee of $175. Your registration will not be processed until payment is received. If you are in need of financial assistance, please contact our office. We are happy to help.

Sacrament Registration

Fill out the form below to register for First Communion only if you:*Are older than 2nd grade *are aN OLMA studentor for Confirmation preparation for grades 9 and upThere is a sacrament fee of $175

Upon submission of this form you will be directed to the Parish Giving Website to pay the sacrament fee of $175. Your registration will not be processed until payment is received. If you are in need of financial assistance, please contact our office. We are happy to help.

Fill out the form below to register for
First Communion
only if you:
Are older than 2nd grade
are aN OLMA student

or for Confirmation preparation for
grades 9 and up

There is a sacrament fee of $175