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  • Parent First and Last Name REQUIRED Please fill out this field. Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • Street Address 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.
  • • Number of Children you are Registering REQUIRED Please fill out this field.
    • Child's Name 1
      • Child's Name REQUIRED Please fill out this field. Please enter valid data.
      • Grade REQUIRED (Select One) Grade 1 Grade 2 Grade 3 Grade 4 Grade K Grade Pre-K (Parent Participation REQUIRED) Please fill out this field.
    • Child's Name 2
      • Child's Name REQUIRED Please fill out this field. Please enter valid data.
      • Grade REQUIRED (Select One) Grade 1 Grade 2 Grade 3 Grade 4 Grade K Grade Pre-K (Parent Participation REQUIRED) Please fill out this field.
    • Child's Name 3
      • Child's Name REQUIRED Please fill out this field. Please enter valid data.
      • Grade REQUIRED (Select One) Grade 1 Grade 2 Grade 3 Grade 4 Grade K Grade Pre-K (Parent Participation REQUIRED) Please fill out this field.
    • Child's Name 4
      • Child's Name REQUIRED Please fill out this field. Please enter valid data.
      • Grade REQUIRED (Select One) Grade 1 Grade 2 Grade 3 Grade 4 Grade K Grade Pre-K (Parent Participation REQUIRED) Please fill out this field.
    • Child's Name 5
      • Child's Name REQUIRED Please fill out this field. Please enter valid data.
      • Grade REQUIRED (Select One) Grade 1 Grade 2 Grade 3 Grade 4 Grade K Grade Pre-K (Parent Participation REQUIRED) Please fill out this field.
  • Emergency/Medical REQUIRED

    Emergency Contact (other than parent listed above) and All Medical Conditions including ALLERGIES

    Please fill out this field.
  • Parent Consent for Release REQUIRED Yes, I consent to having my child(ren) photographed and consent to release those photos to Sts. Simon and Jude for possible use on parish advertisements, parish website and social media sites. No, I do not consent to having my child(ren) photographed and consent to release those photos to Sts. Simon and Jude for possible use on parish advertisements, parish website and social media sites. Please fill out this field.

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