Altar Server Registration

Please complete this registration form if you would like to serve as an Atar Server.

Family Information

Family Last Name

First Name*

Last Name*

Address

Street 1*

Street 2

City*

State*

Zip*

Are you registered members of St. Theresa the Little Flower?
Required*

	Yes
	No
	I don't know

Father's Name

Father's Phone

Father's Email

Father's Address (if different from child)

Street 1

Street 2

City

State

Zip

Mother's Name

Mother's Phone

Mother's Email

Mother's Address (if different from child)

Street 1

Street 2

City

State

Zip

Best Email to Send Updates

Required*

Best Phone

Required* --

Serving other than weekend Mass
Required*

	Yes
	No

Are you interested in Altar Serving during bishop visits, Funerals, Weddings or other occasions other than weekend Mass?

PHOTO RELEASE:
Required*

Faith Formation is allowed to take photos of my child(ren) to be used in the Parish Bulletin and the Parish Website*

	Yes
	No

Special Needs or Concerns

Please describe any medical issues, learning or physical disabilities, allergies, or other concerns we should know.

Child #1 Registration

Full Legal Name

First Name*

Middle Name

Last Name*

Nickname

Date of Birth

Required* //

Gender
Required*

	Female
	Male

Grade

Required*

Select the grade your student is registering for:

Sacraments Already Received
Required*

	Baptism
	First Reconciliation
	First Communion

	Confirmation
	None

Child's E-mail

Only to be used for schedule and reminder emailing.

Child #2 Registration

Full Legal Name

First Name

Middle Name

Last Name

Nickname

Date of Birth

Gender

	Female
	Male

Grade

Sacraments Already Received

	Baptism
	First Reconciliation
	First Holy Communion

	Confirmation
	None

Child's E-mail

Only to be used for schedule and reminder emailing.

Child #3 Registration

Full Legal Name

First Name

Middle Name

Last Name

Nickname

Date of Birth

Gender

	Female
	Male

Grade

Sacraments Already Received

	Baptism
	First Reconciliation
	First Holy Communion

	Confirmation
	None

Child's E-mail

Only to be used for schedule and reminder emailing.

Child #4 Registration

Full Legal Name

First Name

Middle Name

Last Name

Nickname

Date of Birth

Gender

	Female
	Male

Grade

Sacraments Already Received

	Baptism
	First Reconciliation
	First Holy Communion

	Confirmation
	None

Child's E-mail

Only to be used for schedule and reminder emailing.

Altar Server Registration

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