New Family Religious Education Registration

If you would like more information regarding registering your child for Religious Education please fill out the form below or contract Mrs. Lori Humenik, Director of Religious Education, at the Parish Office by phone at 772-231-0671 or by email at lhumenik@holycrossverobeach.org.

Student Name *

First

Last

Parent Name-Father *

First

Last

Parent Name-Mother *

First

Last

Mailing Address

Phone Number *

• Father
• Mother

Phone Number *

• Father
• Mother

Email *

• Father
• Mother

Email

• Father
• Mother

Emergency Contact-Relationship *

School *

Grade Level

Baptism-Date & Church

First Eucharist-Date & Church

First Reconciliation-Date & Church

Confirmation-Date & Church

Allergies or Pertinent Medical History

Media Acknowledgement-Do you consent for your child's photo to be placed in the Church's bulletin/social media? *

• Yes
• No

Comment or Message

Please include any comments or questions you may have so we will be prepared to assist you.

Submit