Holy Name of Jesus Parish Religious Education Registration 2021-2022
Kathryn Sisto, Coordinator of Religious Education                                                                       718-768-7629
hnjreligioused@gmail.com 
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Student Information
Student's name *
Public School Grade
Date of birth *
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Home address *
Family Information
Primary parents name *
Primary parents phone number *
Primary parents email address
Primary parents religion *
Secondary parents name
Secondary parents phone number
Secondary parents email address
Secondary parents religion
Student lives with *
Primary language spoken at home *
Required
Siblings (names and ages)
Mail should be addressed to (name and address) *
Sacramental Information
If your child is new to our program, please email a copy of his/her birth and baptismal certificates to Kathryn Sisto at hnjreligioused@gmail.com
My child has been Baptized Roman Catholic *
If Baptized, name of church (including city & state) and date where he/she was baptized
My child has received First Holy Communion *
If your child has received First Holy Communion, name of church (including city & state) and date where he/she received First Holy Communion
School Information
Public school your child will be attending in September 2021 *
2021-2022 Public school grade *
Additional Information
Does your child have any allergies we should be aware of *
Does your child have any special education needs, medical conditions or custody considerations that we should be aware of. *
In case of emergency, if parents cannot be reached, please contact (name, cell phone number and relationship to child) *
I give permission for Holy Name of Jesus Parish to use photos of my child that were taken while they are attending Religious Education classes or Church events on the Holy Name of Jesus website and/or the Holy Name of Jesus Parish Facebook page *
Registration fee for 2021-2022, $75 for one child, $125 for two siblings or $175 for three or more siblings.   If paying by check, please make check out to Holy Name of Jesus Religious Education.  Checks can be mailed to Holy Name of Jesus Religious Education Program, Attention  Kathryn Sisto, 241 Prospect Park West, Brooklyn, NY 11215.  If you would like to pay in person by check or cash please contact Kathryn Sisto at 718-768-7629 to arrange a convenient day and time. If you are unable to pay the registration fee please complete the registration form and contact Kathryn Sisto.
By submitting this form I ______________ (parents name) am registering my child for the 2021-2022 Religious Education Program at Holy Name of Jesus Parish. I give permission for my child to participate in the Child Lures Safety Program as part of the Religious Education program. *
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