2022-2023 SRRE Registration

- Faith Formation

Online Registration Form
The maximum number of form submissions has been reached. This form is currently not available.
- Today's Date REQUIRED Please fill out this field. Please enter a date.
- Number of Children You Wish to Register REQUIRED Please fill out this field.
  
  Child 1
  
  Child First Name (no nicknames please) REQUIRED Please fill out this field. Please enter valid data.
  
  Child Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth (City & State) REQUIRED Please fill out this field. Please enter valid data.
  
  Child Gender REQUIRED Please fill out this field.
  
  Preferred Day and Time for Class (select only one) REQUIRED Sundays, 7:05 - 8:20 p.m. – Grades 3-8 Mondays, 4:30 - 5:45  p.m. - Grades K-8 Mondays, 7:00 - 8:15 p.m. – Grades 1-12 Family Catechesis (Six Sundays at 4:30-5:45 p.m.) - Grades K-8 Please fill out this field.
  
  Please note: The schedule of in-person classes may change, depending on the availability of volunteer catechists for the various grade levels.
  
  Has the child been baptized? REQUIRED Please fill out this field.
  
  If you answered YES, please fill out the fields below and bring a copy of the baptismal certificate to the SRRE office (unless we already have one on file.)
  If you don't remember the correct date, please write "Can't Remember."
  If you answered NO, please write: "Tentative Baptismal Date _Mo_/_Day_/_Yr_" and write N/A in the remaining church fields.
  
  Date of Baptism - Month/Day/Year (required even if baptized at St. Raphael) Please enter valid data.
  
  Baptismal Church REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City and State (or foreign country) REQUIRED Please fill out this field. Please enter valid data.
  
  ZIP Code Please enter valid data.
  
  Has the child already received Communion? REQUIRED Please fill out this field.
  
  Has the child already received Confirmation? REQUIRED Please fill out this field.
  
  Grade in School September 2022 REQUIRED Please fill out this field.
  
  School attending in September 2022 REQUIRED Please fill out this field. Please enter valid data.
  
  Special Circumstances. In the field below, please let us know if there are any special circumstances that could affect your child learning and participation in our classes and that we should know of (for ex.: Allergies, learning and other disabilities, marital or custody issues, etc.) This information is kept strictly confidential.
  
  Special Circumstances
  
  Child 4
  
  Child First Name (no nicknames please) REQUIRED Please fill out this field. Please enter valid data.
  
  Child Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth (City & State) REQUIRED Please fill out this field. Please enter valid data.
  
  Child Gender REQUIRED Please fill out this field.
  
  Preferred Day and Time for Class (select only one) REQUIRED Sundays, 7:05 - 8:20 p.m. – Grades 3-8 Mondays, 4:30 - 5:45  p.m. - Grades K-8 Mondays, 7:00 - 8:15 p.m. – Grades 1-12 Family Catechesis (Six Sundays at 4:30-5:45 p.m.) - Grades K-8 Please fill out this field.
  
  Please note: The schedule of in-person classes may change, depending on the availability of volunteer catechists for the various grade levels.
  
  Has the child been baptized? REQUIRED Please fill out this field.
  
  If you answered YES, please fill out the fields below and bring a copy of the baptismal certificate to the SRRE office (unless we already have one on file.)
  If you don't remember the correct date, please write "Can't Remember."
  If you answered NO, please write: "Tentative Baptismal Date _Mo_/_Day_/_Yr_" and write N/A in the remaining church fields.
  
  Date of Baptism - Month/Day/Year (required even if baptized at St. Raphael) Please enter valid data.
  
  Baptismal Church REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City and State (or foreign country) REQUIRED Please fill out this field. Please enter valid data.
  
  ZIP Code Please enter valid data.
  
  Has the child already received Communion? REQUIRED Please fill out this field.
  
  Has the child already received Confirmation? REQUIRED Please fill out this field.
  
  Grade in School September 2022 REQUIRED Please fill out this field.
  
  School attending in September 2022 REQUIRED Please fill out this field. Please enter valid data.
  
  Special Circumstances. In the field below, please let us know if there are any special circumstances that could affect your child learning and participation in our classes and that we should know of (for ex.: Allergies, learning and other disabilities, marital or custody issues, etc.) This information is kept strictly confidential.
  
  Special Circumstances
  
  Child 5
  
  Child First Name (no nicknames please) REQUIRED Please fill out this field. Please enter valid data.
  
  Child Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth (City & State) REQUIRED Please fill out this field. Please enter valid data.
  
  Child Gender REQUIRED Please fill out this field.
  
  Preferred Day and Time for Class (select only one) REQUIRED Sundays, 7:05 - 8:20 p.m. – Grades 3-8 Mondays, 4:30 - 5:45  p.m. - Grades K-8 Mondays, 7:00 - 8:15 p.m. – Grades 1-12 Family Catechesis (Six Sundays at 4:30-5:45 p.m.) - Grades K-8 Please fill out this field.
  
  Please note: The schedule of in-person classes may change, depending on the availability of volunteer catechists for the various grade levels.
  
  Has the child been baptized? REQUIRED Please fill out this field.
  
  If you answered YES, please fill out the fields below and bring a copy of the baptismal certificate to the SRRE office (unless we already have one on file.)
  If you don't remember the correct date, please write "Can't Remember."
  If you answered NO, please write: "Tentative Baptismal Date _Mo_/_Day_/_Yr_" and write N/A in the remaining church fields.
  
  Date of Baptism - Month/Day/Year (required even if baptized at St. Raphael) Please enter valid data.
  
  Baptismal Church REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City and State (or foreign country) REQUIRED Please fill out this field. Please enter valid data.
  
  ZIP Code Please enter valid data.
  
  Has the child already received Communion? REQUIRED Please fill out this field.
  
  Has the child already received Confirmation? REQUIRED Please fill out this field.
  
  Grade in School September 2022 REQUIRED Please fill out this field.
  
  School attending in September 2022 REQUIRED Please fill out this field. Please enter valid data.
  
  Special Circumstances. In the field below, please let us know if there are any special circumstances that could affect your child learning and participation in our classes and that we should know of (for ex.: Allergies, learning and other disabilities, marital or custody issues, etc.) This information is kept strictly confidential.
  
  Special Circumstances
  
  Child 2
  
  Child First Name (no nicknames please) REQUIRED Please fill out this field. Please enter valid data.
  
  Child Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth (City & State) REQUIRED Please fill out this field. Please enter valid data.
  
  Child Gender REQUIRED Please fill out this field.
  
  Preferred Day and Time for Class (select only one) REQUIRED Sundays, 7:05 - 8:20 p.m. – Grades 3-8 Mondays, 4:30 - 5:45  p.m. - Grades K-8 Mondays, 7:00 - 8:15 p.m. – Grades 1-12 Family Catechesis (Six Sundays at 4:30-5:45 p.m.) - Grades K-8 Please fill out this field.
  
  Please note: The schedule of in-person classes may change, depending on the availability of volunteer catechists for the various grade levels.
  
  Has the child been baptized? REQUIRED Please fill out this field.
  
  If you answered YES, please fill out the fields below and bring a copy of the baptismal certificate to the SRRE office (unless we already have one on file.)
  If you don't remember the correct date, please write "Can't Remember."
  If you answered NO, please write: "Tentative Baptismal Date _Mo_/_Day_/_Yr_" and write N/A in the remaining church fields.
  
  Date of Baptism - Month/Day/Year (required even if baptized at St. Raphael) Please enter valid data.
  
  Baptismal Church REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City and State (or foreign country) REQUIRED Please fill out this field. Please enter valid data.
  
  ZIP Code Please enter valid data.
  
  Has the child already received Communion? REQUIRED Please fill out this field.
  
  Has the child already received Confirmation? REQUIRED Please fill out this field.
  
  Grade in School September 2022 REQUIRED Please fill out this field.
  
  School attending in September 2022 REQUIRED Please fill out this field. Please enter valid data.
  
  Special Circumstances. In the field below, please let us know if there are any special circumstances that could affect your child learning and participation in our classes and that we should know of (for ex.: Allergies, learning and other disabilities, marital or custody issues, etc.) This information is kept strictly confidential.
  
  Special Circumstances
  
  Child 3
  
  Child First Name (no nicknames please) REQUIRED Please fill out this field. Please enter valid data.
  
  Child Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth (City & State) REQUIRED Please fill out this field. Please enter valid data.
  
  Child Gender REQUIRED Please fill out this field.
  
  Preferred Day and Time for Class (select only one) REQUIRED Sundays, 7:05 - 8:20 p.m. – Grades 3-8 Mondays, 4:30 - 5:45  p.m. - Grades K-8 Mondays, 7:00 - 8:15 p.m. – Grades 1-12 Family Catechesis (Six Sundays at 4:30-5:45 p.m.) - Grades K-8 Please fill out this field.
  
  Please note: The schedule of in-person classes may change, depending on the availability of volunteer catechists for the various grade levels.
  
  Has the child been baptized? REQUIRED Please fill out this field.
  
  If you answered YES, please fill out the fields below and bring a copy of the baptismal certificate to the SRRE office (unless we already have one on file.)
  If you don't remember the correct date, please write "Can't Remember."
  If you answered NO, please write: "Tentative Baptismal Date _Mo_/_Day_/_Yr_" and write N/A in the remaining church fields.
  
  Date of Baptism - Month/Day/Year (required even if baptized at St. Raphael) Please enter valid data.
  
  Baptismal Church REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City and State (or foreign country) REQUIRED Please fill out this field. Please enter valid data.
  
  ZIP Code Please enter valid data.
  
  Has the child already received Communion? REQUIRED Please fill out this field.
  
  Has the child already received Confirmation? REQUIRED Please fill out this field.
  
  Grade in School September 2022 REQUIRED Please fill out this field.
  
  School attending in September 2022 REQUIRED Please fill out this field. Please enter valid data.
  
  Special Circumstances. In the field below, please let us know if there are any special circumstances that could affect your child learning and participation in our classes and that we should know of (for ex.: Allergies, learning and other disabilities, marital or custody issues, etc.) This information is kept strictly confidential.
  
  Special Circumstances
- Family's Preferred Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Street Address (where the children live) 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.
- Mother's First 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.
- Mother's Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Mother's Email REQUIRED Please fill out this field. Please enter an email address.
- Father's First and Last Name REQUIRED Please fill out this field. Please enter valid data.
- Father's Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Father's Email REQUIRED Please fill out this field. Please enter an email address.
- Family's Parish Envelope Number Please enter valid data.
- Family's preferred language for communication with the office Please enter valid data.
- Emergency Contact (other than a parent)
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Relationship to the child / children REQUIRED Please fill out this field. Please enter valid data.
- Tuition and Fees Statement: I understand that to enroll children in Religious Education the parish requires payment of annual tuition and sacramental fee (the latter only for children receiving Sacraments in Spring 2023). I commit to pay the appropriate amount either electronically, by check or cash (please make appointment to pay in cash) within 30 days.
  
  Tuition:
  
  $155 for 1 child
  
  $230 for 2 children in the same family
  
  $280 for 3 or more children in the same family
  
  Sacramental Fees:
  
  $75 - First Eucharist in Spring 2023
  
  $75 - Confirmation in Spring 2023
  
  Families who are struggling financially should contact DRE Mary Beaudoin to discuss available options (payment plan, scholarship, discount, exemption, etc.)
  mbeaudoin@straphaels.org
  I Understand and Agree Please select this field.
Submit

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Links to E-Payment for Religious Education
- Click Here to Pay Tuition and/or Sacramental Fee (Amount is indicated in the payment form)
Payments by Check

Please send checks to:

St. Raphael Church
Office of Religious Education - ATTN: Pietro Lojacono
1513 Dunster Rd.
Rockville, MD 20854

Please do not send cash by mail. For cash paymnts, please make an appointment to meet a staff member in the office. Thank you.