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CCD at home Registration

- CCD/Religious Ed

Virtual Learning 2021-2022 REgistration
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- Today's Date REQUIRED Please fill out this field. Please enter a date.
- Parent/Guardian Information
  
  Father's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Cell # REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Name: 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 Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Whose phone number is the Primary? REQUIRED Mom Dad Please fill out this field.
  
  Child lives with 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.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
- In Case of an Emergency who is the contact?
  
  Contact's Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to child REQUIRED Please fill out this field.
  
  Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Child's Name
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  DOB REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Grade (in which they are entering) REQUIRED Please fill out this field.
  
  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.
  
  Sacraments Completed: REQUIRED Baptism Confession Communion Please fill out this field.
- Do you attend church @ St. Theodore? REQUIRED yes no Please fill out this field.
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St. Theodore Catholic Church

337-855-6662

CCD at home Registration

Virtual Learning 2021-2022 REgistration