FIRST RECONCILIATION AND EUCHARIST REGISTRATION - St. John the Evangelist, Plaquemine, LA

Child's Full Name *

Date of Birth *

Grade *

School Attending *

Mother's Full Name *

Father's Full Name *

Mailing Address *

Home Phone *

Work Phone *

Mother's Cell Phone *

Mother's Email *

Father's Cell Phone *

Father's Email *

NO FEES. Please make a donation directly to St. John the Evangelist Church, Plaquemine, LA.