Religious Education Registration 2022-23

Parent or Guardian Last Name*
Mother's First Name
Father's First Name
Primary Email*
Secondary Email (specify Mother/ Father/ Other)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone (Specify Mom Cell/Dad Cell or other)*
Phone (Specify Mom Cell/Dad Cell or other)
Emergency Contact Name and Phone Number and Relationship*

Student <1 > Full Name (First, Middle and Last)*
Student <1> Sex*
- Male
- Female
Student <1> First Choice Class Option (or other schooling)*
Class options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12), Monday 4:45 – 6:15 PM (Grades K – 8) or Rite of Christian Initiation for Children (RCIC)
Student <1> Second Choice Class Option
Class options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12) or Monday 4:45 – 6:15 PM (Grades K – 8)
Student <1> Academic Grade in 2025-26*
Check the box if Student <1> has special needs
- Check the box if Student has special needs
Student <1> Special Student Accommodations (this information will be kept confidential): Please note any allergies or other pertinent information, including special educational accommodations (IEP, 504, etc.), which will help us to provide a positive learning environment for your child. By leaving this blank, you are stating that your child has no need for special accommodations.
Student <1> Date of Birth (DD/MM/YYYY)*
Student <1> Sacraments Already Received*
- Baptism
- First Penance
- First Holy Communion
- Confirmation
Student <1> Lives With Whom (Both parents, joint custody, or one parent)*
If Student <1> does not live with parents, please list with whom they live and what their relationship to them is.
Where did Student <1> receive their Religious Education last year? (Name and location of Parish)*

Student <2> Full Name (First, Middle and Last)
Student <2> Sex
- Male
- Female
Student <2> First Choice Class Option (or other schooling)
Class options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12), Monday 4:45 – 6:15 PM (Grades K – 8) or Rite of Christian Initiation for Children (RCIC)
Student <2> Second Choice Class Option
Class options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12) or Monday 4:45 – 6:15 PM (Grades K – 8)
Student <2> Academic Grade in 2025-26
Student <2> Date of Birth (DD/MM/YYYY)
Student <2> Sacraments Already Received
- Baptism
- First Penance
- First Holy Communion
- Confirmation
Check the box if Student <2> has special needs
- Check the box if Student has special needs
Student <2> Special Student Accommodations (this information will be kept confidential): Please note any allergies or other pertinent information, including special educational accommodations (IEP, 504, etc.), which will help us to provide a positive learning environment for your child. By leaving this blank, you are stating that your child has no need for special accommodations.
Student <2> Lives With Whom (Both parents, joint custody, or one parent)
If Student <2> does not live with parents, please list with whom they live and what their relationship to them is.
Where did Student <2> receive their Religious Education last year? (Name and location of Parish)

Student <3 > Full Name (First, Middle and Last)
Student <3> Sex
- Male
- Female
Student <3> First Choice Class Option
Class options include: Schedule Sunday 5:00 – 6:30 PM (Grades 1 – 12), Monday 4:45 – 6:15 PM (Grades K – 8) or Rite of Christian Initiation for Children (RCIC)
Student <3> Second Choice Class Option
Class options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12) or Monday 4:45 – 6:15 PM (Grades K – 8)
Student <3> Academic Grade in 2025-26
Student <3> Date of Birth (DD/MM/YYYY)
Student <3> Sacraments Already Received
- Baptism
- First Penance
- First Holy Communion
- Confirmation
Check the box if Student <3> has special needs
- Check the box if Student has special needs
Student <3> Special Student Accommodations (this information will be kept confidential): Please note any allergies or other pertinent information, including special educational accommodations (IEP, 504, etc.), which will help us to provide a positive learning environment for your child. By leaving this blank, you are stating that your child has no need for special accommodations.
Where did Student <3> receive their Religious Education last year? (Name and location of Parish)

Student <4> Full Name (First, Middle and Last)
Student <4> Sex
- Male
- Female
Student <4> First Choice Class Option
Class options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12), Monday 4:45 – 6:15 PM (Grades K – 8) or Rite of Christian Initiation for Children (RCIC)
Student <4> Second Choice Class Option
Class options include: Schedule Sunday 5:00- 6:30 PM (Grades 1 – 12) or Monday 4:45 – 6:15 PM (Grades K – 8)
Student <4> Academic Grade in 2025-26
Student <4> Date of Birth (DD/MM/YYYY)
Student <4> Sacraments Already Received
- Baptism
- First Penance
- First Holy Communion
- Confirmation
Check the box if Student <4> has special needs
- Check the box if Student has special needs
Student <4> Special Student Accommodations (this information will be kept confidential): Please note any allergies or other pertinent information, including special educational accommodations (IEP, 504, etc.), which will help us to provide a positive learning environment for your child. By leaving this blank, you are stating that your child has no need for special accommodations.
Where did Student <4> receive their Religious Education last year? (Name and location of Parish)

I hereby authorize the Diocese of Arlington and St. Raymond of Penafort Catholic Church to use my child’s picture or video for educational and/or marketing purposes.
- Yes
- No
I acknowledge that I am aware of my role and responsibility of primary catechist of my children. I agree to comply with the policies and requirements of the St. Raymond Religious Education program. Please sign below by typing your full name. Include your relationship to the student(s) and date.
SAFE ENVIRONMENT LESSONS The Office of Child Protection and Safety for the Diocese of Arlington provides programs to ensure a safe environment for children within the community of the Church. The Diocese of Arlington requires a training program designed for youth to permit them to be a last line of defense and to ensure every child has the tools necessary to combat abuse. For children in grades 1-12 Religious Education, St. Raymond Catholic Church uses the Circle of Grace program. Contact the RE office for more information. INFORMATION ON THIS PROGRAM IS AVAILABLE ON THE DIOCESAN WEBSITE: http://www.arlingtondiocese.org/Child-Protection/Youth-Training-Programs/
- Yes. my child(ren) may participate
- No, my child(ren) will not participate
Carpool Authorization- Name and Phone Number
I am interested in volunteering to teach, assist, or be a substitute for this school year.
- Yes
- Not at this time
The FCPS Family Life Education Program (FLE) contains elements which compromise Church teachings. Have you opted your child(ren) out of this program?
- Yes
- No
Optional Notes
Below is the “Submit” button. It only needs to be pushed one time. All required fields must be filled in order to register. If you receive an error message that states you are missing information, please go back and find missing fields, then push submit. If you receive a message that starts “Notice: bbp_setup_current_user was called incorrectly” this indicates that we did receive your registration. You should receive an email from us confirming your registration was received.

Online Registration for Religious Education

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