CCD Registration Form

Location

United States

See map: Google Maps

Student Information

Full Name *

Male or Female *

Male

Female

Address *

City *

Zip *

School Attending *

Grade *

Date of Birth *

Month

Day

Year

Place of Birth *

City, State and Zip

Baptism *

Month

Day

Year

Name and Location of Church *

First Eucharist *

Month

Day

Year

Name and Location of Church *

Last CCD school attended

Date of attendance

Month

Day

Year

Parental Information

Father's Name *

Religion *

Address *

Cell Phone Number *

Work Phone Number *

Email *

Mother's Name *

Religion *

Address *

Cell Phone Number *

Work Phone Number

Email *

Who does the Student live with? *

In an emergency call *

Name and Phone Number Other Than Parent

Church Parish where you are registered or attend Mass regularly *

Does your child have any allergies or special needs? *

Photo Permissions *

Yes

Parent Signature *

Please type your name to give permission for your child to participate.

Date Registered *

Month

Day

Year

A $30 registration fee is due along with the submission of this form. Please check your email to pay online or bring the fee to the church office at 401 21^st Street.

Cash

Check Number

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