Old St. Mary's Family Religious Education Program

You may fill out the form here online and submit it or you may download printable version of the form. Download Form.

* Denotes Required Field

Enrollment Form: 2011-2012

*Child's Name

*Date of Birth

*Age

*School

*Grade in School

*Father's Name

Catholic?

*Mother's Name

Catholic?

*Street Address

*City

*State

*Zip

*Home Phone

Work Phone

Mobile Phone

*E-Mail

Is there anything we should know about your child, i.e learning disability, food allergy, etc.?

Please indicate which Sacraments your child has received

Baptism Reconciliation Eucharist Confirmation

Please complete a separate form for each child to be enrolled in the program and enclose the fee for one year with your enrollment: $105.00 for the first child and $75.00 for each additional child.

Please send enrollment forms and payment to:

Old St. Mary's Church
Attn: Maryann Cushing
1500 S. Michigan Avenue
Chicago, IL. 60605

Classes are held Sunday mornings in the school classrooms from 9:45 - 10:45 AM. First class will be September 11, 2011.

Verification: Enter Code

*Enter Verification Image Code