Nido-Toddler Atrium New Registration

Child's Full Name REQUIRED Please fill out this field. Please enter valid data.

Child's Date of Birth REQUIRED Please fill out this field. Please enter a date.

Was Child Baptized? REQUIRED Yes No Please fill out this field.

Date of Baptism REQUIRED Please fill out this field. Please enter a date.

Home Address REQUIRED

Please include both street address and if applicable, PO Box number

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.

Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Child resides with REQUIRED Both parents Mother Father Legal guardian Please fill out this field.

Child's Allergy Information

Does this child have any known allergies? REQUIRED Yes No Please fill out this field.

If "yes" please specify Please enter valid data.

Is there any additional information we should know about your child? Are there any special health considerations? REQUIRED

Please enter "NONE" if there are no concerns we need to be aware of.

Please fill out this field.

Complete the contact information for the
CHILD'S MOTHER below:

Type mother's first name and maiden name below:

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.

Is the mother's address the same as the one listed for the child? REQUIRED Yes No Please fill out this field.

If "no" please enter your address below.

Home Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Religion REQUIRED Please fill out this field. Please enter valid data.

Complete the contact information for the
CHILD'S FATHER below:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Is the father's address the same as the one listed for the child? REQUIRED Yes No Please fill out this field.

If "no" please enter your address below.

Home Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Religion REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Information

Emergencies in the Atrium are highly unlikely, but it is good practice to have a plan in place so everyone understands what will happen in the event of unexpected emergency.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Best Phone Contact REQUIRED Please fill out this field. Please enter a phone number.

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.

Fee Submission Information

My registration fee will be submitted by: REQUIRED Please fill out this field.

St. John the Evangelist (Pawling, NY)
St. Charles Borromeo (Dover Plains, NY)

Nido-Toddler Atrium New Registration

Catechesis of the Good Shepherd Registration

Complete the contact information for the
CHILD'S MOTHER below:

Complete the contact information for the
CHILD'S FATHER below:

Nido-Toddler Atrium New Registration

Complete the contact information for the CHILD'S MOTHER below:

Complete the contact information for the CHILD'S FATHER below:

Complete the contact information for the
CHILD'S MOTHER below:

Complete the contact information for the
CHILD'S FATHER below: