Saint Therese Parish

(OFFICE USE: ______Permanent Record Updated/Created)

2017 – 2018 SAINT THERESE PARISH CCD REGISTRATION

Please complete and return this form to CCD on the first day of CCD so that your child’s records are up-to-date and accurate and that we can reach you in the case of an emergency.

PLEASE PRINT ALL INFORMATION. Please complete both sides of the form.

A form must be completed even if the information has not changed from last year.

A separate form must be completed for each child.

Your child will not be permitted to stay in class without a completed form.

Student’s Last NameFirst Name Middle NameDate of Birth School Grade

Address Street CityZipcode

______Email address(es)

Home Phone Number Mother’s Cell Phone Number Father’s Cell Phone Number

School Attending(District/Building)Parish to which family belongs

Father’s Last NameFirst Name Religion

Mother Last Name First NameMaiden Name Religion

Emergency Contacts (other than Parent)Phone NumbersRelationship to Child

______

Emergency Contacts (other than Parent)Phone NumbersRelationship to Child

Sacraments Received By Child

Baptism*______

Date ChurchLocation

*If this is your child’s first year at CCD, you must submit a copy of their Baptismal Certificate unless they were baptized at Saint Therese. Special note to Grade 2 parents for the 2017 – 2018 year: if your child WAS NOT baptized at Saint Therese, you must also submit a copy of their Baptismal Certificate. Please send the copy of the certificate into CCD by October 21, 2017.

First Communion ______

Date ChurchLocation

Confirmation ______

Date ChurchLocation

IMPORTANT – Registration form continues on the back.

Child’s Name: ______

Health & Well-being Information

Does your child have learning needs?

Learning Disability – Classification: ______

Other – Please Explain: ______

______

Does your child have any medical conditions? (Please explain)

__Allergies: ______

__ Other conditions: ______

Are there any custodial issues?

___ Yes: Please explain and indicate the Custodial Parent:

Any further information concerning allergies, physical, social or learning disabilities, family situations, personal problems, etc., which could better enable us to help your child?

YOUR HELP IS NEEDED –

Volunteers are needed as:

Catechists

Co-catechists (team teaching)

Substitute Catechists

Special Event Aides/Reception Volunteers

Office Help

Religious Education classes are held on Saturdays from 10:00 – 11:30 (grades 1-5)

and on Tuesdays from 6:00 – 7:30 (grades 6-8) starting in September and ending in April.

I am interested in more information about becoming a

______Catechist

______Co-catechist (team teaching)

______Substitute Catechist

______Special Events Aide/Reception Volunteer

______Talking about other ways in which I can help