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MSLRP SACRAMENT REQUEST FORM 2011-2012

I am requesting in the following sacrament(s) for my child (please circle).


Baptism

st

1 Reconciliation (Confession)

st

1 Eucharist (Communion)

st

1 Childs Name__________________________________________ Grade (as of Sept. 2011) _______

Fathers Name _______________________________ Mothers Name___________________________


Address: _____________________________________________________________________________
(Street)

(City)

(Zip Code)

Email Address _________________________________________ Phone # ________________________

Have you attended the Parent Sacramental Program?

(please circle)

Yes

No

Have you received the certificate?

(please circle)

Yes

No

In what language did you wish to attend the Parent Sacramental Program?

English

Spanish

Signature: _____________________________________________________

Date: _______________

Signature must be that of parent and/or legal guardian.

I am requesting in the following sacrament(s) for my 2


Baptism

st

1 Reconciliation (Confession)

nd

child also (please circle).


st

1 Eucharist (Communion)

nd

2 Childs Name__________________________________________ Grade (as of Sept. 2011) _______

Fathers Name _______________________________ Mothers Name___________________________

Have you completed the Parent Sacramental Program? (please circle)

Yes

No

Have you received the certificate?

Yes

No

(please circle)

In what language did you wish to attend the Parent Sacramental Program?

English

Signature: _____________________________________________________

Date: ______________

Signature must be that of parent and/or legal guardian.

LL gold sac req

Spanish

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