RCIC Questionnaire

Child's Name Please enter valid data.

Child's Age Please enter an integer (number).

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Place of Birth Please enter valid data.

Child's Address 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.

Home Phone REQUIRED Please fill out this field. Please enter a phone number.

School Attending Please enter valid data.

Current Grade Please enter valid data.

Does the Child have special needs/services at school?

Child's Favorite Activities/Hobbies

Names and Ages of Siblings

As per diocesan guidelines, sacraments must be received in the parish the family is registered in. Please check the box below to indicate if you are a registered parishioner of St. George or another church parish of our diocese.

Registered Parishioner REQUIRED St. George Other Please fill out this field.

If other, please add Parish name Please enter valid data.

Are the mother & father an active part of the child's life? Yes No

If no, please explain.

Are the child's parents married? Yes No

If married, were they married in the Catholic Church? Yes No

Does the Child have step-parents in his/her life? Yes No

If yes, what is the religious affiliation of the step-parent? Please enter valid data.

Your relationship to the child: Please enter valid data.

Parent/Guardian with whom the child lives: Please enter valid data.

Guardian Name Please enter valid data.

Address, if different from child: Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Home Phone REQUIRED Please fill out this field. Please enter a phone number.

Mobile Phone Please enter a phone number.

Work Phone Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.