Old St. Mary's Family Religious Education Program
Enrollment form

You may fill out the form here online and submit it OR you may go HERE for a printable version of the form.
Today's Date:
Child's Name:
 Date of Birth
School
Grade in School
Age
Catholic?
Mother's Name
Catholic?
Father's Name
Address
Home Phone
 Work Phone
Email Address
Is there anything we should know about your child, i.e learning disability, food allergy, etc.?
Please indicate which Sacraments your child has received:
Please complete a separate form for each child to be enrolled in the program and enclose the fee for
one year with your enrollment: $75.00 for the first child and $55.00 for each additional child.

You may submit this enrollment online and bring the fee to Mrs. Maryann Cushing or you may print out
your completed form(s) and mail them to:

Mrs. Maryann Cushing
Old St. Mary's Church
1500 S. Michigan Ave.
Chicago, IL.  60605





Classes are held Sunday mornings in the school classrooms from 9:30 - 10:45 AM
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