C.C.D. Registration

Student Last Name *

Student's First and Middle Name (if any) *

Date of Birth *

Birth Place (City, State) *

Age (How Many Years) *

Gender *MaleFemale

Date of Baptism *

Place of Baptism (Name of Church) *

Location of Church (City & State) *

Current Grade(Class) *

Do You have another ChildYesNo

2 Student's First and Middle Name (if any) *

2 Student Last Name *

2 Date of Birth *

2 Birth Place (City, State) *

2 Age (How Many Years) *

2 Gender *MaleFemaleNot to specify

2 Baptism Date *

2 Place of Baptism (Name of Church) *

2 Location of Church (City & State) *

2 Current Grade *

Street Address *

City *

State *

ZIP / Postal code *

Father's First Name, Middle Name (if any)

Father's Last Name

Father's Email Email Address

Father's Phone

Mother's First Name, Middle Name (if any)

Mother's Maiden Name

Mother's Email Address

Mother's Phone

Is the family registered? (Select the Church) *

Name of the Church *

In Which Church child wants to attend CCD Class? *

Emergency Contact Name (other than parents) *

Emergency Contact Phone Number (other than parents) *

If your child has any allergies, please list here *

In my absence, I hereby give consent to any staff member to provide all emergency care prescribed by a duly licensed physician for my child. This care may be given under whatever conditions are necessary to preserve the life or wellbeing of my dependent. *I AgreeI Don't Agree

Photo Release: Please check the box below as your authorization for Most Holy rosary or Most Precious Blood Church to use your child's image for the church bulletin or website, as it pertains to Religious Education. *I give permissionI do not give permission

Most Holy rosary or Most Precious Blood Religious Education Ministry presents "Empowering God's Children and Young People Safety Program", developed by the Office of Safeguard the Children. It is taught by a trained instructor and is age appropriate. I allow my child to participate in "Empowering God’s Children and Young People Safety Program on the topic of "Boundaries and Bullying". I specifically request that Most Holy rosary or Most Precious Blood CCD/Confirmation present the program to my child. *YesNo

Please choose the appropriate Registration fee payment below. *$10.00 – 1 Child$15.00 – 2 Children$25.00 – 3 Children

Other Amount (Want to Donate To CCD)

C.C.D. Registration School Year 2024-2025 Open for Enrollment

C.C.D. Registration
School Year 2024-2025
Open for Enrollment