St. Perpetua Church

A Catholic Community in Lafayette, California
Celebrating our faith, enriching our community, sharing our gifts

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Reconciliation Registration

- Faith Formation
  - Adult Formation
    
    Adults
  - Youth Formation
    
    Children 1st - 5th Grade
    
    Fall Registration
    Reconciliation Registration
    
    High School Youth Ministry
    TEAM 6th - 8th Grade

Registration Fee ($25)

Click here to pay on line" name="Click here to pay on line" target="_blank">Click here to pay on line (select Faith Formation).
or return check to:
ATTN: Kim Anderson
St. Perpetua Faith Formation
3454 Hamlin Road
Lafayette, CA 94549
Registration Form
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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.
- Grade of Child REQUIRED Please fill out this field. Please enter an integer (number).
- Place of Birth (city, state) REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Baptized at St Perpetua REQUIRED Yes No * Please fill out this field.
- *Name of Church, City and State Please enter valid data.
- Baptism Date REQUIRED Please fill out this field. Please enter a date.
- Mother's Information
  Maiden Name
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Baptized Catholic Yes No
- Father'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.
- Baptized Catholic Yes No
- 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.
- Email REQUIRED Please fill out this field. Please enter an email address.
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If you have any questions or need assistance please contact kima@stperpetua.org