St. Theodore Catholic Church

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CCD Online Registration

- Religious Education

CCD Pre-Registration 2018-2019
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- 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.
  
  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:
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  DOB: REQUIRED Please fill out this field. Please enter valid data.
  
  Gender: Male Female
  
  Grade REQUIRED Please fill out this field.
  
  CCD Times Grades 1-5 @ 4pm Grades 1-5 @ 5:30pm Grades 6-8 @ 7pm Home School
  
  City of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  City & State of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Sacraments Completed: Baptism Confession Communion
  
  Sacramental preparation needed this year? Yes No
  
  SPECIAL NEEDS/COMMENTS: (medical, learning, physical or special requests):
  
  Birth Father: Please enter valid data.
  
  Cell # Please enter valid data.
  
  Birth Mother: Please enter valid data.
  
  Cell # Please enter valid data.
  
  Mother's Maiden Name: Please enter valid data.
- Child #2:
  
  Name Please enter valid data.
  
  DOB: Please enter valid data.
  
  Gender: Male Female
  
  Grade
  
  CCD Times Grades 1-5 @ 4pm Grades 1-5 @ 5:30pm Grades 6-8 @ 7pm Home School
  
  City of Birth Please enter valid data.
  
  City & State of Baptism Please enter valid data.
  
  Church of Baptism Please enter valid data.
  
  Sacraments Completed: Baptism Confession Communion
  
  Sacramental preparation needed this year? Yes No
  
  SPECIAL NEEDS/COMMENTS: (medical, learning, physical or special requests):
  
  If different birth father/mother please fill the following:
  
  Birth Father: Please enter valid data.
  
  Cell # Please enter valid data.
  
  Birth Mother: Please enter valid data.
  
  Cell # Please enter valid data.
  
  Mother's Maiden Name: Please enter valid data.
- Child #3:
  
  Name Please enter valid data.
  
  DOB: Please enter valid data.
  
  Gender: Male Female
  
  Grade
  
  CCD Times Grades 1-5 @ 4pm Grades 1-5 @ 5:30pm Grades 6-8 @ 7pm Home School
  
  City of Birth Please enter valid data.
  
  Church of Baptism Please enter valid data.
  
  City & State of Baptism Please enter valid data.
  
  Sacraments Completed: Baptism Confession Communion
  
  Sacramental preparation needed this year? Yes No
  
  SPECIAL NEEDS/COMMENTS: (medical, learning, physical or special requests):
  
  If different birth father/mother please fill the following:
  
  Birth Father: Please enter valid data.
  
  Cell # Please enter valid data.
  
  Birth Mother: Please enter valid data.
  
  Cell # Please enter valid data.
  
  Mother's Maiden Name: Please enter valid data.
- 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 2018-2019 CCD $30 for ONE student in grades 1-8 $60 for TWO students in grades 1-8 $80 for THREE students in grades 1-8
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