RCIA-Adapted for Children Interest Form

Full Name (please include middle name) Please enter valid data.

Date of Birth Please enter valid data.

Place of Birth Please enter valid data.

Grade Level Please enter valid data.

School Please enter valid data.

I. Parent/Guardian Information

Name Please enter valid data.

Relationship Please enter valid data.

Religious Affiliation Please enter valid data.

Name Please enter valid data.

Relationship Please enter valid data.

Religious Affiliation Please enter valid data.

Full Mailing Address Please enter valid data.

Phone Number Please enter valid data.

Email Please enter valid data.

Child/Teen lives with: Parents Mother Only Father Only Other

If other please explain

If child/teen lives with one parent/guardian, please indicate who has legal custody and/or if the child/teen also lives with a step parent:

if there is a joint custody arrangement, please provide alternate full address

II. Religious History

Has your child/teen ever been baptized? Yes No I am not sure

If you answered "yes" please provide the following information:

In what denomination was your child/teen baptized? Please enter valid data.

Date or approximate age when your child/teen was baptized: Please enter valid data.

Baptismal Name (if different from current name): Please enter valid data.

Place of Baptism (name of church/denomination): Please enter valid data.

Address, if known: Please enter valid data.

Location, if known: Please enter valid data.

If your child/teen was baptized as a Catholic, check those sacraments he/she has received Confession Eucharist Confirmation

For a teen: Has he/she been married or is he/she currently married? Never been married Is currently married Has been married

III. Family Information

List the name(s) of any siblings (e.g. John - Brother; Jean - Stepsister)

Siblings REQUIRED Please fill out this field.
Sibling 1
- Name Please enter valid data.
- Relationship Please enter valid data.
- Age Please enter valid data.
Sibling 2
- Name Please enter valid data.
- Relationship Please enter valid data.
- Age Please enter valid data.
Sibling 3
- Name Please enter valid data.
- Relationship Please enter valid data.
- Age Please enter valid data.
Sibling 4
- Name Please enter valid data.
- Relationship Please enter valid data.
- Age Please enter valid data.
Sibling 5
- Name Please enter valid data.
- Relationship Please enter valid data.
- Age Please enter valid data.
Sibling 6
- Name Please enter valid data.
- Relationship Please enter valid data.
- Age Please enter valid data.
Sibling 7
- Name Please enter valid data.
- Relationship Please enter valid data.
- Age Please enter valid data.

IV. Learning Style

Not all people learn in the same way. You can help your child/teen get as much out of this process as possible by sharing about your child/s learning abilities.
In what ways do you think your child/teen enjoys learning?

Listening (lecture; storytelling)

Seeing (Looking at pictures; identifying symbols; watching a video)

Reading (At what grade level does your child/teen read? Does your child enjoy reading?)

Writing (At what level is your child/teen's writing skills? Does your child/teen like to write stories?/keep a journal?)

Hands On (Does your child/teen enjoy doing projects or making crafts?)

Group Work (Does your child/teen enjoy working with others?)

It will be helpful to know your child/teen's strongest attributes and challenges. Please add below any helpful details that you think would be relevant.

V. General Questions

Please describe the types of religious education in which your child/teen has participated

What contact has your child/teen had with the Catholic Church to date?

What are some of the questions or concerns your child/teen has about the Catholic Church?

Please summarize below the reason(s) your child/teen desires to begin the Christian initiation process