New Enrollment

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Parish Affiliation REQUIRED Please fill out this field. Please enter valid data.
Father'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.
- Street 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.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number Cell REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Phone Other Please enter valid data.
- Father's Religion REQUIRED Please fill out this field. Please enter valid data.
Mother'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.
- Street 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.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number Cell REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Phone Number Other Please enter valid data.
- Mother's Religion REQUIRED Please fill out this field. Please enter valid data.
Stepparent/Guardian Information (if applicable)
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Email Please enter an email address.
- Phone Number Cell Maximum 20 characters Please enter a phone number.
- Phone Number Other Please enter valid data.
Emergency Contact 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.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Relationship to the student REQUIRED Please fill out this field. Please enter valid data.
I understand that one of the primary goals of this program is reestablishing, empowering and equipping parents to fulfill their role as the primary educators of the faith. Parents have the duty and responsibility to be the primary educators of their children; certainly, the home is even referred to as the “domestic church.”..., that is, the parents will instruct their children in the faith by their words, deeds and particularly, example of lifelong formation – catechesis does not and should not end with Confirmation but is a pilgrimage over the course of each person’s life
I Agree Please select this field.
- Number of Children to be Registered REQUIRED Please fill out this field.
- Student 1
  - 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 Entering 2022-23 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother primarily Father primarily Guardian Please fill out this field.
  - Sacraments Received Baptism First Communion Confirmation
  - My child has previously attended religious education REQUIRED Yes No Please fill out this field.
  - If applicable, where did student last attend religious education? Please enter valid data.
  - Medical Concerns/Issues Please enter valid data.
  - Food Allergies Please enter valid data.
  - I give my permission to Pilgrim Cluster Religious Education Program to use my child's photograph in print or online publications and media. REQUIRED Yes, I do give permission. No, I do not give permission. Please fill out this field.
- Student 2
  - 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 Entering 2022-23 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother primarily Father primarily Guardian Please fill out this field.
  - Sacraments Received Baptism First Communion Confirmation
  - My child has previously attended religious education REQUIRED Yes No Please fill out this field.
  - If applicable, where did student last attend religious education? Please enter valid data.
  - Medical Concerns/Issues Please enter valid data.
  - Food Allergies Please enter valid data.
  - I give my permission to Pilgrim Cluster Religious Education Program to use my child's photograph in print or online publications and media. REQUIRED Yes, I do give permission. No, I do not give permission. Please fill out this field.
- Student 3
  - 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 Entering 2022-23 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother primarily Father primarily Guardian Please fill out this field.
  - Sacraments Received Baptism First Communion Confirmation
  - My child has previously attended religious education REQUIRED Yes No Please fill out this field.
  - If applicable, where did student last attend religious education? Please enter valid data.
  - Medical Concerns/Issues Please enter valid data.
  - Food Allergies Please enter valid data.
  - I give my permission to Pilgrim Cluster Religious Education Program to use my child's photograph in print or online publications and media. REQUIRED Yes, I do give permission. No, I do not give permission. Please fill out this field.
- Student 4
  - 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 Entering 2022-23 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother primarily Father primarily Guardian Please fill out this field.
  - Sacraments Received Baptism First Communion Confirmation
  - My child has previously attended religious education REQUIRED Yes No Please fill out this field.
  - If applicable, where did student last attend religious education? Please enter valid data.
  - Medical Concerns/Issues Please enter valid data.
  - Food Allergies Please enter valid data.
  - I give my permission to Pilgrim Cluster Religious Education Program to use my child's photograph in print or online publications and media. REQUIRED Yes, I do give permission. No, I do not give permission. Please fill out this field.
- Student 5
  - 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 Entering 2022-23 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother primarily Father primarily Guardian Please fill out this field.
  - Sacraments Received Baptism First Communion Confirmation
  - My child has previously attended religious education REQUIRED Yes No Please fill out this field.
  - If applicable, where did student last attend religious education? Please enter valid data.
  - Medical Concerns/Issues Please enter valid data.
  - Food Allergies Please enter valid data.
  - I give my permission to Pilgrim Cluster Religious Education Program to use my child's photograph in print or online publications and media. REQUIRED Yes, I do give permission. No, I do not give permission. Please fill out this field.
- Student 6
  - 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 Entering 2022-23 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother primarily Father primarily Guardian Please fill out this field.
  - Sacraments Received Baptism First Communion Confirmation
  - My child has previously attended religious education REQUIRED Yes No Please fill out this field.
  - If applicable, where did student last attend religious education? Please enter valid data.
  - Medical Concerns/Issues Please enter valid data.
  - Food Allergies Please enter valid data.
  - I give my permission to Pilgrim Cluster Religious Education Program to use my child's photograph in print or online publications and media. REQUIRED Yes, I do give permission. No, I do not give permission. Please fill out this field.
- Student 7
  - 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 Entering 2022-23 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother primarily Father primarily Guardian Please fill out this field.
  - Sacraments Received Baptism First Communion Confirmation
  - My child has previously attended religious education REQUIRED Yes No Please fill out this field.
  - If applicable, where did student last attend religious education? Please enter valid data.
  - Medical Concerns/Issues Please enter valid data.
  - Food Allergies Please enter valid data.
  - I give my permission to Pilgrim Cluster Religious Education Program to use my child's photograph in print or online publications and media. REQUIRED Yes, I do give permission. No, I do not give permission. Please fill out this field.
- Student 8
  - 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 Entering 2022-23 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother primarily Father primarily Guardian Please fill out this field.
  - Sacraments Received Baptism First Communion Confirmation
  - My child has previously attended religious education REQUIRED Yes No Please fill out this field.
  - If applicable, where did student last attend religious education? Please enter valid data.
  - Medical Concerns/Issues Please enter valid data.
  - Food Allergies Please enter valid data.
  - I give my permission to Pilgrim Cluster Religious Education Program to use my child's photograph in print or online publications and media. REQUIRED Yes, I do give permission. No, I do not give permission. Please fill out this field.
We are interested in the following groups/activities: Women's Book Study Group Hospers Women's Study Group Christ Our Life Conference (for families) Sept. 26-27

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Pilgrim Cluster

Catholic Parishes - Alton/Granville/Hospers, IA

New Enrollment

Pilgrim Cluster New Enrollment Form