First Reconciliation &amp; First Communion Registration

Registration for the 2026 - 2027 Youth First Reconciliation & Communion Preparation Program for Mary Queen of Heaven PSR

St. Ann, St. Bernard and St. James Churches
ST. ANN, ST. BERNARD, AND ST. JAMES PARENT PROMISE:

My child and I are registered parishioners in one of the three churches of Mary, Queen of Heaven Family of Parishes.
I understand my PSR student(s) need to submit the Archdiocese of Cincinnati emergency medical, liability, and Media release form, prior to the first PSR sacrament prep class meeting.
I understand that I must submit a baptismal record for my child. It is due at the parent orientation meeting or by Monday, October 5th.
I understand that I am required to attend the parent sacrament information meeting.
I will assist and pray for my child as he/she is preparing for these sacraments.
I will make Sunday Mass attendance a priority for our family.
I am aware of the schedule of classes, retreat, and practice for First Reconciliation & Eucharist., and will prioritize preparation for the period in which it takes place, understanding that repeated absences could result in delayed reception of the sacraments.

I acknowledge the above information and will comply in a timely fashion with all that is necessary for reception of the sacrament for my child.

I Agree Please select this field.

My child has attended religious ed previously through REQUIRED Please fill out this field.

If you selected another Catholic Parish or Other, please list below... Please enter valid data.

Please check off all grades attended for religious education: REQUIRED 1 2 3 4 5 6 7 8 0 Please fill out this field.

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.
Full Name (as should appear on certificate, bulletin and program) REQUIRED Please fill out this field. Please enter valid data.
Nick Name Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

City and State of Birth REQUIRED Please fill out this field. Please enter valid data.

Age REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Please fill out this field.

Child's School REQUIRED Please fill out this field. Please enter valid data.

Child's Grade for the 2026 - 2027 School Year REQUIRED Please fill out this field. Please enter valid data.

Language Spoken REQUIRED Please fill out this field.

Is your child able to receive instruction in English? REQUIRED Please fill out this field.

Does your child have any learning disabilities which would affect their entering preparation with other children? REQUIRED Please fill out this field.

(If yes, we will want to meet with you to outline a plan for reception of the sacrament. Please contact Mrs. McSwane.)

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.

Family Email Address REQUIRED Please fill out this field. Please enter valid data.

Secondary Family Email Address Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Secondary Phone Number Please enter valid data.

Child primarily resides with REQUIRED Please fill out this field.

Name of Guardian REQUIRED Please fill out this field. Please enter valid data.

Primary Guardian Phone Number REQUIRED Please fill out this field. Please enter valid data.

Parishioner Status REQUIRED Please fill out this field.

Parish registration is required for all sacrament preparation.

Emergency Contact 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.

Relationship to child REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Child's Sacramental Information

A baptismal record must be requested by calling the parish office where your child was baptized. The record is due at the parent orientation meeting or by Monday, September 29th.
The child was baptized at the following church: REQUIRED Please fill out this field.
If at another parish, please write in that church name below, including the city and state. Please enter valid data.
Baptismal Date or Year REQUIRED Please fill out this field. Please enter valid data.
Mother's Full Name REQUIRED Please fill out this field. Please enter valid data.
Mother's Maiden Name (if married) REQUIRED Please fill out this field. Please enter valid data.
Mother's Religion REQUIRED Please fill out this field. Please enter valid data.
Mother's 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.
Mother's Marital Status REQUIRED Please fill out this field.
If remarried, please provide spouse's name: Please enter valid data.
Father's Full Name REQUIRED Please fill out this field. Please enter valid data.
Father's Religion REQUIRED Please fill out this field. Please enter valid data.
Father's Address (if different) Please enter valid data.
City Please enter valid data.

State

Zip Please enter a zip code.
Father's Marital Status REQUIRED Please fill out this field.
If remarried, please provide spouse's name: Please enter valid data.
If parents are divorced or separated, please list CUSTODIAL PARENT: Please enter valid data.
ADDITIONAL INFORMATION:
- I understand my PSR student(s) need to submit the Archdiocese of Cincinnati emergency medical, liability and media release form prior to the first class meeting.
- I understand that I must submit a baptismal record for my child. It is due at the parent orientation meeting or by Monday, October 5th.
- I understand that I am required to attend the parent information meeting.
I Agree Please select this field.
Today's Date REQUIRED Please fill out this field. Please enter valid data.
Comments or Questions Please enter valid data.

Mary Queen of Heaven

Cincinnati, OH

First Reconciliation & First Communion Registration

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