2024 First Eucharist Sacrament Form

Thank you for taking the time to fill out the 2023-2024 Sacramental Form for your child receiving the Sacraments of First Reconciliation and First Holy Eucharist. Filling out this form ensures we have the correct student and parent information. Please fill out this form no later than Wednesday, January 10, 2024 .

We are also collecting copies of your child’s baptism certificate for those who were not baptized at St. Raymond Parish. Please have a jpeg, png, or pdf copy of the baptism certificate ready at the time you complete the form.

We know that this is a special time and we are blessed to be accompanying your family on this faith journey. If you have any questions or need any assistance please reach out to Sharon Moeykens, s.moeykens@st-raymond.org, or 847-253-8600 x164. We look forward to celebrating with you and your families.

2024 First Eucharist Sacrament Form

Step 1 of 3

Child Information
Family Last Name(Required)
Child's Baptismal Name(Required)
As it appears on the baptism certificate
First Middle Last Suffix
Family Information
Mother's Name (first, maiden, last)(Required)
First Maiden Last
Father's Name (first and last)(Required)
First Last
Address(Required)
Street Address City State ZIP Code
Primary Email(Required)
Additional Email
Primary Phone Number(Required)
Additional Phone Number

Additional Information and Waivers
Please share any know allergies and/or medical needs.(Required)
The First Eucharist Retreat typically offers an allergy-friendly snack. This information will help ensure student health safety and best serve individual needs. If none, write N/A.
I allow my child's first and last name to appear in the parish bulletin when all the first communicants are announced in April/May.(Required)
- Yes
- No
Please share with us any special family accommodations that will be needed for Mass on April 27, 2024.
Example: Handicapped or wheelchair accessible etc...A blank response indicates no accommodations are required. (Please leave blank no accommodations are needed)
Photography Waiver(Required)
I give St. Raymond de Penafort Parish permission to use photo(s) of my child taken during the program or parish event for communications (including but not limited to: bulletin, newsletter, website, posters, and other public relations material, including email, Facebook, Twitter, Instagram, and other similar forms of social media communication).
- I agree to the photography policy
- I don't agree to the photography policy
Emergency Contact(Required)
Please provide the name and number phone number for an emergency contact (not a parent).
Medical Waiver(Required)
If the parents or guardians cannot be contacted in case of serious injury or illness, I authorize St. Raymond de Penafort staff to take emergency action deemed necessary, including the transportation of the student to a hospital or medical center. As a parent or guardian, I authorize the treatment by a qualified and licensed medical doctor of the minor(s) listed in this registration in the event of a medical emergency that, in the opinion of the attending physician, may endanger his/her life, cause disfigurement or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me.
- I agree to the Medical Waiver
Signature Confirmation
By typing your name below you are indicating that you have double-checked the spelling of your child's name as it will appear on the First Eucharist certificate. **Please note: We will only use your child's first and last name when printing in the St. Raymond parish bulletin.**
Typed Signature

2024 First Eucharist Sacrament Form

2024 First Eucharist Sacrament Form

Step 1 of 3

Child Information

Family Information

Baptismal Information

Additional Information and Waivers

Signature Confirmation