St. John the Baptist

Catholic Church

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Youth Ministry Registration

- Contact Us
  
  Gina DeLaTorre
  
  Youth Ministry & Confirmation Director
  
  510 815-0050‬
  youthministrysjtbc.us
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Child's 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Grade (In Fall of Current Year) REQUIRED
  In Fall of Current Year
  Please fill out this field.
  
  Age REQUIRED Please fill out this field.
  
  Parent/Guardians
  
  Father/Guardian's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father/Guardian's Cell# REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Father/Guardian's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mother/Guardian's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother/Guardian's Cell# REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Mother/Guardian's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mother/Guardian's Religion REQUIRED
  If none type "N/A"
  Please fill out this field. Please enter valid data.
  
  Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Home Address REQUIRED Please fill out this field. 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.
  
  Sacramental Information
  
  Has your child been baptized? REQUIRED Please fill out this field.
  
  If "Yes", please specify the date.
  
  Baptism Date Please enter a date.
  
  What church was your child baptized at? Please enter valid data.
  
  Place of Baptism Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Does your child need First Communion? REQUIRED Please fill out this field.
  
  Children with Special Needs:
  
  Children Religious Education Fees REQUIRED Please fill out this field.
  
  Total:
  
  Submit
  
  Proceed to Payment
  
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