1st Communion Registration Form

- Sacraments

Your family must be registered parishioners of St. Pius X Church to receive a Sacrament here.

Please contact Cass at 757-381-7122 or email [email protected]
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- Child's 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 a date.
  
  Grade 2022-2023 REQUIRED Please fill out this field. Please enter valid data.
  
  School addending REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Baptism REQUIRED Please fill out this field. Please enter a date.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Address of Church of Baptism Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Father's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's MAIDEN Name REQUIRED Please fill out this field. Please enter valid data.
  
  Family Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Parent Information
  
  Mother's Cell phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Mother's Email Address REQUIRED Please fill out this field. Please enter an email address.
  
  Father's Cell Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Father's Email Address REQUIRED Please fill out this field. Please enter an email address.
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