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OCIA for Children - Intake Form

- Please use the form below to provide specific information about your child enrolled in our OCIA for Children program. Fill out the form only after speaking with either Father Kevin Segerblom or Kathy Boyer.
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Child's full name REQUIRED Please fill out this field. Please enter valid data.
  
  Child's Date of birth REQUIRED Please fill out this field. Please enter a date.
  
  Child's place of birth (city and state) REQUIRED Please fill out this field. Please enter valid data.
  
  Child's Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Child's School REQUIRED Please fill out this field. Please enter valid data.
  
  Mailing 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.
  
  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.
  
  Mother's full name - including MAIDEN name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's religion REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  What sacraments are you seeking for your child? (please check one) Placement in OCIA-C program will depend on level of formation. REQUIRED Full Initiation: Baptism, Confirmation, Eucharist (Child is unbaptized and over the age of 7) Reception into the full communion of the Catholic Church: Confirmation and Eucharist (child is over the age of 7, uncatechized, and already been baptized) Confirmation only (Child has already been baptized and received Holy Communion) Please fill out this field.
  
  If child has already been baptized, please indicate in which Church: REQUIRED Unbaptized Roman Catholic Catholic, other rite (please specify in text box below) Eastern Orthodox (please specify which church or rite in text box below) Other - please specify in text box below Please fill out this field.
  
  Please specify previous baptism information. If unbaptized, simply write "unbaptized". REQUIRED Please fill out this field.
  
  After you click "SUBMIT", you should see a confirmation screen. If you do not, please contact Kathy Boyer at [email protected].
  
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