CCD Online Registration

Today's Date: REQUIRED Please fill out this field. Please enter a date.

Parent/Guardian Information

Father REQUIRED Please fill out this field. Please enter valid data.
Father's Cell # REQUIRED Please fill out this field. Please enter valid data.
Mother REQUIRED Please fill out this field. Please enter valid data.
Mother's Maiden Name: REQUIRED Please fill out this field. Please enter valid data.
Mother's Cell # REQUIRED Please fill out this field. Please enter valid data.
Child lives with: REQUIRED Please fill out this field. Please enter valid data.
Relationship to Child: 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.
Zip Code: REQUIRED Please fill out this field. Please enter valid data.
E-mail Address: REQUIRED Please fill out this field. Please enter valid data.
Primary Phone # REQUIRED Please fill out this field. Please enter valid data.
Emergency Contact REQUIRED Please fill out this field. Please enter valid data.
Relationship to Child: REQUIRED Please fill out this field. Please enter valid data.
Phone # REQUIRED Please fill out this field. Please enter valid data.

Child #1:

Child #2:

Child #3:

Other:

Do we have permission to photograph your child for CCD, church website, and/or bulletin purposes? Yes No
Do you attend Church at St. Theodore Catholic Church? Yes No

PAYMENT IS:

Please choose amount for 2019-2020 CCD $35 for ONE student in grades 1-8 $65 for TWO students in grades 1-8 $90 for THREE students in grades 1-8

St. Theodore Catholic Church