- 2020/2021 Confirmation
  Year 2 Registration (9th grade)
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Registration is due by September 15th, 2020. A late fee of $50 will be added to registrations received after this date.
  
  Student's First and Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Current School and Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Church, City and State of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Home 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.
  
  Mother's First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Last Name Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  Father's First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  Parishioner Information
  
  Is the family registered at St. Timothy Church? REQUIRED No Please register our family. Yes Please fill out this field.
  
  If registered, please indicate ID/ENVELOPE # REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact (other than parents) REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  If your child has any allergies, please list here Please enter valid data.
  
  In my absence, I hereby give consent to any St. Timothy staff member to provide all emergency care prescribed by a duly licensed physician for my child. This care may be given under whatever conditions are necessary to preserve the life or wellbeing of my dependent.
  
  I Agree Please select this field.
  
  Photo Release: Please check the box below as your authorization for St. Timothy Church to use your child's image for the church bulletin or website, as it pertains to Religious Education.
  
  I Agree Please select this field.
  
  Please choose the appropriate payment below REQUIRED Please fill out this field.
  
  Total:
  
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St. Timothy Parish

Los Angeles, CA

2020/2021 Confirmation
Year 2 Registration (9th grade)