Circle of Grace Communion Registration

Child's Age(Required)

Grade Level In School(Required)

What Parish do you attend most often?

Mother's Cell Phone(Required)

Mother's Email(Required)

Father's Phone(Required)

Father's Email(Required)

Emergency Contact Phone(Required)

Emergency Contact Relationship to Child(Required)

Nature of special need or disability, please be specific. (Example: ASD, SLD, VI, SI, ...)(Required)

Any known allergies?(Required)

Other medical conditions?(Required)

Fears and dislikes?(Required)

Interests and likes?(Required)

Who will be attending the communion program with your child every Saturday? What is their relationship to your child?(Required)

Does your child have any siblings attending communion with them this year? If so, please list their name and age.(Required)

Is there anything else you would like us to know about your child?(Required)

Total Cost for Communion(Required)

Price:

CC Processing Fees

Price: $0.00

Total

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