Family Registration Form

When you submit this form, all of the information will be sent by e-mail to Our Lady of Good Counsel.

* Required fields
  Student-* Type     
Title *First Name *Last Name Suffix
Birth Date:   Gender:  Female  Male
Sacraments Rcv      Date
Baptism
Penance
First Comm
Confirm
To fill out the form ...Please make your first and second choice of classes.
1st Class Choice
Alternate Choice
Additional Information (Special Circumstances, medication, allergies...)

* Required fields
Head of Household
Title * First Name * Last Name Suffix
Birth Date:   * Gender:  Female  Male
Spouse
Title First Name Last Name Suffix
Birth Date:   Gender:  Female  Male
Address
* Line 1
   Line 2
* City
* State
* ZIP
   E-Mail
Send E-Mail Instead of Mail When Possible
Phone
* Primary ( ) - Unlisted
   Other ( ) - Unlisted
Emergency Contact Information
Title First Name Last Name Suffix
Relationship  
Address for Emergency Contact
Line 1  
City    
State    
Zip       -
Email    use Email
Phone for Emergency Contact
Primary Phone    
() - Unlisted
Other Phone       
() - Unlisted

When you submit this form, all of the information will be sent by e-mail to Our Lady of Good Counsel.