FIRST RECONCILIATION AND EUCHARIST REGISTRATION

Child's Full Name *

Gender *

Male

Female

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.

Last Name

57805 Main Street
Plaquemine, Louisiana 70764

Phone: 225-687-2402
Fax: 225-687-1587
Prayer Line: 225-687-1554

E-mail: stjohnchurchplaq@coxbusiness.net