Registration

Please complete one form per child. If the basic information is the same, you may leave it blank but you must fill in the required pieces of information.

First Name REQUIRED Please fill out this field. Please enter valid data.

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.

Gender

Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Email Please enter an email address.

Phone Number Please enter a phone number.

Secondary Phone Number Please enter a phone number.

School Child Attends Please enter valid data.

Grade Level REQUIRED Please fill out this field. Please enter valid data.

Which Sacraments has your child ALREADY received? REQUIRED Baptism (in a Catholic church) Baptism (in a non-Catholic church) Reconciliation Eucharist Confirmation Please fill out this field.

Which Sacraments, if any, are you intending for your child to receive THIS YEAR? REQUIRED Baptism First Reconciliation First Eucharist Confirmation Unsure Please fill out this field.

Father's Name Please enter valid data.

Father's Religion Please enter valid data.

Father's Place of Employment and Position Please enter valid data.

Mother's Name Please enter valid data.

Mother's Religion Please enter valid data.

Mother's Place of Employment and Position Please enter valid data.

Material and Supply Fees are $30 I will pay through the Online Giving link on the website (PSR Tuition is an option-please select it if paying this way) I will bring cash/check to the office or to orientation I am struggling financially and need assistance

Will someone be attending parent orientation on September 20? If so, how many people? REQUIRED Please fill out this field. Please enter valid data.

Child Protection

The Child Protection Policy of the Diocese of Belleville requires that we provide age-appropriate abuse prevention education programs for children and youth attending our Faith Formation programs. Presentations are age-appropriate and include various issues related to abuse prevention. Many area public schools already provide this class to students.
Does your child's grade school offer an abuse prevention education program for children, such as "Body Boundaries"? REQUIRED Please fill out this field.
Would you like to be notified and included in the session offered at St. Mary School? REQUIRED Please fill out this field.

Publicity Release

I hereby grant permission for St. Mary Catholic Church to use pictures of my child, listed with this registration for the following: REQUIRED Local or Diocesan newspaper articles On St. Mary Catholic Church web pages (including St. Mary Facebook page) Publicity materials promoting St. Mary Catholic Church (fliers, bulletins, etc.) Please fill out this field.
By clicking submit I agree to the publicity release. Please note, no names or other personal information will be used on web based media.

St.Mary Immaculate Conception Catholic

1550 Main Street, Mount Vernon, Illinois

618.244.1559

Registration

Registration for Grades 1-8