RELIGIOUS EDUCATION

APPLICATION FORM

FOR RETURNING STUDENTS

Tuition: $350 is due at registration through Venmo: @Epiphany22

Payment through Tithe.ly and Credit Card requires a 4% service fee.

CLICK HERE TO PAY VIA TITHE.LY

Sacramental Fee for First Communion or Confirmation: $375 is due November 18,2022

Payment Plans are available upon request.

Please make checks payable to Church of The Epiphany

To register your RETURNING child, please fill out the form below and SUBMIT IT!

Today's Date

MM

DD

YYYY

Name of Child

First Name

Last Name

Address (Include Apt Number)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's Date of Birth

Public/Private School Child is attending

Grade of this upcoming September school year

Mother's first and MAIDEN name

First Name

Last Name

Mother's cell

(###)

###

####

Father's name

First Name

Last Name

Father's cell

(###)

###

####

Name of Caregiver who will Pick Up Your Child

Cell of Caregiver who will Pick Up Your Child

(###)

###

####

Permission for Your Child to Go Home Alone

YES

NO

Does your child have any medical or physical disabilties? Does your child have any allergies, IEP? Is there anything we should be aware of to tailor the instruction to the child's needs?

NAME OF EMERGENCY CONTACT PERSON

RELATIONSHIP OF EMERGENCY CONTACT PERSON

EMAIL OF EMERGENCY CONTACT PERSON

Electronic Signature

PHONE NUMBER OF EMERGENCY CONTACT PERSON

(###)

###

####