CATHOLIC SCHOOL STUDENTS ONLY - Registration Form for First Eucharist

- Faith Formation

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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Place of Birth (City) REQUIRED Please fill out this field. Please enter valid data.
- State of Birth REQUIRED Please fill out this field.
- Date of Baptism (Required even if baptized at St. Raphael) REQUIRED Please fill out this field. Please enter a date.
- Name of Church Where Baptized REQUIRED Please fill out this field. Please enter valid data.
- Address of Church (unles baptized at St. Raphael) Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Catholic School Attending REQUIRED Please fill out this field. Please enter valid data.
- Grade in Fall 2022 REQUIRED Please fill out this field.
- Mother's First Name REQUIRED Please fill out this field. Please enter valid data.
- Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.
- Mother's Email REQUIRED Please fill out this field. Please enter an email address.
- Father's First and Last Name REQUIRED Please fill out this field. Please enter valid data.
- Father's Email REQUIRED Please fill out this field. Please enter an email address.
- Home Address (where child resides) 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.
- Preferred Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
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Link to Sacramental Fee E-Payment

Note: Submit payment ONLY IF your child or children are receiving sacraments in May 2023
Click Here to pay the sacramental fee (amount is indicated in the payment form)
Payments by check

Please send checks to:

St. Raphael Church
Office of Religious Education - ATTN: Pietro Lojacono
1513 Dunster Rd.
Rockville, MD 20854

Please do not send cash by mail. For cash paymnts, please make an appointment to meet a staff member in the office. Thank you.