Re-Enrollment

The maximum number of form submissions has been reached. This form is currently not available.

Name of Parish Attending 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.
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.
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 2024-25 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother Father Guardian Please fill out this field.
  - 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 2024-25 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother Father Guardian Please fill out this field.
  - 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 2024-25 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother Father Guardian Please fill out this field.
  - 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 2024-25 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother Father Guardian Please fill out this field.
  - 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 2024-25 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother Father Guardian Please fill out this field.
  - 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 2024-25 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother Father Guardian Please fill out this field.
  - 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 2024-25 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother Father Guardian Please fill out this field.
  - 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 2024-25 Please enter valid data.
  - Child Lives With REQUIRED Mother & Father Mother Father Guardian Please fill out this field.
  - 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.

Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Pilgrim Cluster

Catholic Parishes - Alton/Granville/Hospers, IA

Re-Enrollment

Pilgrim Cluster Re-enrollment Form