| Divine Mercy Parish | Peterborough, NH

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12 Church Street
Peterborough, NH
Phone: (603) 924-7647
divinemercynh@comcast.net

- Faith Formation

Parish & Religious Ed. Registration 2017-18
The maximum number of form submissions has been reached. This form is currently not available.
- Parent-Family Information
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
  Registered in this Parish? REQUIRED Yes No Please fill out this field.
  
  Registration Type REQUIRED Parish Religious Education Please fill out this field.
  
  Family Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mailing Address Line 1: REQUIRED
  Enter Street or PO Box
  Please fill out this field. Please enter valid data.
  
  Mailing Address Line 2: 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.
  
  Primary Phone # REQUIRED Please fill out this field. Please enter a phone number.
  
  Secondary Phone Number Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Marital Status REQUIRED Married Single Separated Divorced Single Parent Widow/Widower Please fill out this field.
  
  Date of Marriage Please enter a date.
  
  Fathers Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother Name: (Please Include Maiden Name) REQUIRED Please fill out this field. Please enter valid data.
  
  Send Envelopes
  To Request Parish Collection Envelopes
  Yes No
- 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.
  
  Emergency Contact Relationship: REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Primary Phone # REQUIRED Please fill out this field. Please enter a phone number.
  
  Emergency Contact Secondary Phone # Please enter a phone number.
  
  Photograph Permission:
  Photographs are sometimes taken during faith formation sessions and events. They are displayed publicly; e.g., on parish website, in the newspaper, in a brochure, on bulletin boards, etc. and used to keep the community aware and informed of parish events and activities. If you do not want images taken and used as described, please send a written notice to that effect to the parish. Attention to Catechetical Leader, Jackie Capes at Divine Mercy Parish, 12 Church Street, Peterboorugh, NH 03458.
- Number of Children in Family REQUIRED Please fill out this field.
  
  Child Family Member 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.
  
  Suffix (Jr., Sr,, II, III, etc.)
  Jr. Sr. II III IV or blank
  
  Gender
  
  Grade (Select Grade)
  Required for Rel. Ed Registration - Select School Grade, College or Not in School
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  City & State of Birth Please enter valid data.
  
  Sacraments Completed (Check all received)
  Check all received.
  Baptism Reconciliation Eucharist Confirmation
  
  Date of Baptism Please enter a date.
  
  Place of Baptism Please enter valid data.
  
  Child Family Member 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.
  
  Suffix (Jr., Sr,, II, III, etc.)
  Jr. Sr. II III IV or blank
  
  Gender
  
  Grade (Select Grade)
  Required for Rel. Ed Registration - Select School Grade, College or Not in School
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  City & State of Birth Please enter valid data.
  
  Sacraments Completed (Check all received)
  Check all received.
  Baptism Reconciliation Eucharist Confirmation
  
  Date of Baptism Please enter a date.
  
  Place of Baptism Please enter valid data.
  
  Child Family Member 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.
  
  Suffix (Jr., Sr,, II, III, etc.)
  Jr. Sr. II III IV or blank
  
  Gender
  
  Grade (Select Grade)
  Required for Rel. Ed Registration - Select School Grade, College or Not in School
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  City & State of Birth Please enter valid data.
  
  Sacraments Completed (Check all received)
  Check all received.
  Baptism Reconciliation Eucharist Confirmation
  
  Date of Baptism Please enter a date.
  
  Place of Baptism Please enter valid data.
  
  Child Family Member 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.
  
  Suffix (Jr., Sr,, II, III, etc.)
  Jr. Sr. II III IV or blank
  
  Gender
  
  Grade (Select Grade)
  Required for Rel. Ed Registration - Select School Grade, College or Not in School
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  City & State of Birth Please enter valid data.
  
  Sacraments Completed (Check all received)
  Check all received.
  Baptism Reconciliation Eucharist Confirmation
  
  Date of Baptism Please enter a date.
  
  Place of Baptism Please enter valid data.
  
  Child Family Member 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.
  
  Suffix (Jr., Sr,, II, III, etc.)
  Jr. Sr. II III IV or blank
  
  Gender
  
  Grade (Select Grade)
  Required for Rel. Ed Registration - Select School Grade, College or Not in School
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  City & State of Birth Please enter valid data.
  
  Sacraments Completed (Check all received)
  Check all received.
  Baptism Reconciliation Eucharist Confirmation
  
  Date of Baptism Please enter a date.
  
  Place of Baptism Please enter valid data.
  
  Child Family Member 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.
  
  Suffix (Jr., Sr,, II, III, etc.)
  Jr. Sr. II III IV or blank
  
  Gender
  
  Grade (Select Grade)
  Required for Rel. Ed Registration - Select School Grade, College or Not in School
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  City & State of Birth Please enter valid data.
  
  Sacraments Completed (Check all received)
  Check all received.
  Baptism Reconciliation Eucharist Confirmation
  
  Date of Baptism Please enter a date.
  
  Place of Baptism Please enter valid data.
  
  Child Family Member 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.
  
  Suffix (Jr., Sr,, II, III, etc.)
  Jr. Sr. II III IV or blank
  
  Gender
  
  Grade (Select Grade)
  Required for Rel. Ed Registration - Select School Grade, College or Not in School
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  City & State of Birth Please enter valid data.
  
  Sacraments Completed (Check all received)
  Check all received.
  Baptism Reconciliation Eucharist Confirmation
  
  Date of Baptism Please enter a date.
  
  Place of Baptism Please enter valid data.
  
  Child Family Member 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.
  
  Suffix (Jr., Sr,, II, III, etc.)
  Jr. Sr. II III IV or blank
  
  Gender
  
  Grade (Select Grade)
  Required for Rel. Ed Registration - Select School Grade, College or Not in School
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  City & State of Birth Please enter valid data.
  
  Sacraments Completed (Check all received)
  Check all received.
  Baptism Reconciliation Eucharist Confirmation
  
  Date of Baptism Please enter a date.
  
  Place of Baptism Please enter valid data.
  
  Child Family Member 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Suffix (Jr., Sr,, II, III, etc.)
  Jr. Sr. II III IV or blank
  
  Gender
  
  Grade (Select Grade)
  Required for Rel. Ed Registration - Select School Grade, College or Not in School
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  City & State of Birth Please enter valid data.
  
  Sacraments Completed (Check all received)
  Check all received.
  Baptism Reconciliation Eucharist Confirmation
  
  Date of Baptism Please enter a date.
  
  Place of Baptism Please enter valid data.
  
  Child Family Member 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Suffix (Jr., Sr,, II, III, etc.)
  Jr. Sr. II III IV or blank
  
  Gender
  
  Grade (Select Grade)
  Required for Rel. Ed Registration - Select School Grade, College or Not in School
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  City & State of Birth Please enter valid data.
  
  Sacraments Completed (Check all received)
  Check all received.
  Baptism Reconciliation Eucharist Confirmation
  
  Date of Baptism Please enter a date.
  
  Place of Baptism Please enter valid data.
- Additional Details
  
  Registration Fees:
  Early registration special $40 per child ($60 per family)
  
  After June 30: $50 per child ($75 per family) These fees help support the cost of texts, materials, and supplies. Financial hardship should never keep a child away from Religious Education. If there is a need please speak to Jackie Capes immediately.
  
  Special Needs/Allergies/Medications:
  
  Special Needs:
  Please list child's name & needs. Send procedure plan to parish office if needed.
  
  Snacks:
  Catechists occasionally provide snacks- please contact Jackie Capes in writing if you do not want your child to receive snacks.
  
  Medical Forms:
  If your child needs an epi-pen, inhaler, or any other medical equipment on hand during a session or event please speak with Catechetical Leader, Jackie Capes.
  
  Was each child registered here in Faith Formation last year? REQUIRED Yes No Please fill out this field.
  
  If No, list who, where and what grade?
  
  Baptismal Certificates are required for all students when first registering at this Parish. Please Submit ASAP. Students Baptized at Divine Mercy Parish are exempt from this requirement but must supply the date of Baptism.
  
  Parent Commitment-Attendance at weekly Mass is an essential part of your child’s religious education. Parents who choose to participate in our program are making a firm commitment to see that their child attends Mass on a regular basis.
  
  Parent Signature Required* I acknowledge that as the parent/guardian, this information will be submitted to the parish for use in registration. REQUIRED Yes Please fill out this field.
Submit

Parent Commitment-Attendance at weekly Mass is an essential part of your child’s religious education. Parents who choose to participate in our program are making a firm commitment to see that their child attends Mass on a regular basis.