First Holy Communion Year 2 &lt;div&gt;Information &amp; Registration &lt;/div&gt;

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.

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. REQUIRED I give permission I do not give permission Please fill out this field.

St. Timothy's Religious Education presents a child abuse prevention program, the Touching Safety program. Developed by the creators of Protecting God's Children, it is taught by a trained instructor and is age appropriate. For more information visit the VIRTUS online website at www.Virtus.org

I allow my child to participate in "Empowering God’s Children and Young People Safety Program Year 3: Internet Safety." I specifically request that St. Timothy CCD/Confirmation present the program to my child. REQUIRED Yes No Please fill out this field.

Additional Information Please enter valid data.

Please choose the appropriate payment below. Registration fee will increase $25 after 9/11/22. 325.0 – 1st Child (Includes $100 Sacramental Fee) 275.0 – 2nd Child (Includes $100 Sacramental Fee) 225.0 – 3rd Child (Includes $100 Sacramental Fee) 100.0 – St. Timothy School Student (Sacramental Fee)

Other Amount $ Please enter a positive decimal.

Would you like to cover the 3% processing fee? REQUIRED Yes No Please fill out this field.

St. Timothy Catholic Church

10425 W. Pico Blvd, Los Angeles, CA 90064

First Holy Communion Year 2
Information & Registration

to register for 2022-2023 FHC

First Holy Communion Year 2 Information & Registration

First Holy Communion Year 2
Information & Registration