PREP Forms

Custodial Parent's Name:

Address:

Parish Registered At:

Number of Family in the Household:

Mother's Cell Phone:

Father's Cell Phone:

Email Address:

Mother's Maiden Name:

Is the Mother Catholic?

Yes

No

Is the Father Catholic?

Yes

No

Doctor's Name:

Doctor's Phone Number:

Preferred Hospital:

Emergency Contact Name (Include non-custodial parent if applicable):

Emergency Contact Phone:

My Child / Children are able to have their pictures taken and posted:

Yes

No

1st Child's Name (First and Last):

Birth Date:

Gender:

Check all Religion grades completed (through spring of 2024). Include Catholic school and/or Parish Religious Program.

School Attending:

Current Grade:

Baptism Received:

Yes

No

Baptized Where?

Catholic?

Yes

No

Penance Received?

Yes

No

Eucharist Received?

Yes

No

Penance and Eucharist Received Where?

Will you receive a Sacrament this year?

Yes

No

Known educational / behavioral concerns:

Allergies:

Medications:

2nd Child's Name (First and Last):

Birth Date

Gender:

Check all Religion grades completed (through spring of 2024). Include Catholic school and/or Parish Religious Program.

School Attending:

Current Grade:

Baptism Received:

Yes

No

Baptized Where?

Catholic?

Yes

No

Penance Received?

Yes

No

Eucharist Received?

Yes

No

Penance and Eucharist Received Where?

Will you receive a Sacrament this year?

Yes

No

Known educational / behavioral concerns:

Allergies:

Medications:

3rd Child's Name (First and Last):

Birth Date:

Gender:

Check all Religion grades completed (through spring of 2024). Include Catholic school and/or Parish Religious Program.

School Attending:

Current Grade:

Baptism Received:

Yes

No

Baptized Where?

Catholic?

Yes

No

Eucharist Received?

Yes

No

Penance Received?

Yes

No

Penance and Eucharist Received Where?

Will you receive a Sacrament this year?

Yes

No

Known educational / behavioral concerns:

Allergies:

Medications:

4th Child's Name (First and Last):

Birth Date:

Gender:

Check all Religion grades completed (through spring of 2024). Include Catholic school and/or Parish Religious Program.

School Attending:

Current Grade:

Baptism Received:

Yes

No

Baptized Where?

Catholic?

Yes

No

Penance Received?

Yes

No

Eucharist Received?

Yes

No

Penance and Eucharist Received Where?

Will you receive a Sacrament this year?

Yes

No

Known educational / behavioral concerns:

Allergies:

Medications:

PREP Registration Form

Fees

PREP Registration