CCD Registration 2021-22 Form

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Family's Phone Number REQUIRED Please fill out this field. Please enter valid data.

Family's Email Address REQUIRED Please fill out this field. Please enter valid data.

Preferred Language REQUIRED English Spanish English or Spanish Please fill out this field.

Street 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.

Primary Contact (First and Last Name) REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Catholic? REQUIRED Please fill out this field.

What Sacraments have you completed? REQUIRED Baptism First Communion Confirmation Marriage None Please fill out this field.

Spouse (First and Last Name) Please enter valid data.

Email Please enter an email address.

Phone Number Please enter a phone number.

Catholic?

What Sacraments has your spouse completed? Baptism First Communion Confirmation Marriage None/N/A

Emergency Contact (First and Last Name) REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Relationship to child(ren) REQUIRED Please fill out this field. Please enter valid data.

Will your child attend class Sunday mornings (9:45-11:15 AM) or Monday evenings (6:45- 8:15 PM) REQUIRED Please fill out this field.

How would you like to help this year? Catechist Catechist Assistant Substitute Catechist Office Helper Classroom Maintenance Helper Occasional Special Projects

Number of Children you are registering REQUIRED Please fill out this field.
Child 1
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Child's Age REQUIRED Please fill out this field. Please enter valid data.
- Child's sex REQUIRED male female Please fill out this field.
- Name of CCD Parish of Catholic School Enrolled Last Year ('21-'22), if applicable REQUIRED Please fill out this field. Please enter valid data.
- Child HAS received the following sacraments (select ALL that apply) REQUIRED Baptism Reconciliation Communion Confirmation Has not received any sacraments yet Unsure Please fill out this field.
- School for '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Grade in '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Food allergies, Other Allergies, Other Medical Conditions REQUIRED Please fill out this field.
- Any special needs? REQUIRED Please fill out this field.
Child 2
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Child's Age REQUIRED Please fill out this field. Please enter valid data.
- Child's sex REQUIRED male female Please fill out this field.
- Name of CCD Parish of Catholic School Enrolled Last Year ('21-'22), if applicable REQUIRED Please fill out this field. Please enter valid data.
- Child HAS received the following sacraments (select ALL that apply) REQUIRED Baptism Reconciliation Communion Confirmation Has not received any sacraments yet Unsure Please fill out this field.
- School for '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Grade in '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Food allergies, Other Allergies, Other Medical Conditions REQUIRED Please fill out this field.
- Any special needs? REQUIRED Please fill out this field.
Child 3
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Child's Age REQUIRED Please fill out this field. Please enter valid data.
- Child's sex REQUIRED male female Please fill out this field.
- Name of CCD Parish of Catholic School Enrolled Last Year ('21-'22), if applicable REQUIRED Please fill out this field. Please enter valid data.
- Child HAS received the following sacraments (select ALL that apply) REQUIRED Baptism Reconciliation Communion Confirmation Has not received any sacraments yet Unsure Please fill out this field.
- School for '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Grade in '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Food allergies, Other Allergies, Other Medical Conditions REQUIRED Please fill out this field.
- Any special needs? REQUIRED Please fill out this field.
Child 4
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Child's Age REQUIRED Please fill out this field. Please enter valid data.
- Child's sex REQUIRED male female Please fill out this field.
- Name of CCD Parish of Catholic School Enrolled Last Year ('21-'22), if applicable REQUIRED Please fill out this field. Please enter valid data.
- Child HAS received the following sacraments (select ALL that apply) REQUIRED Baptism Reconciliation Communion Confirmation Has not received any sacraments yet Unsure Please fill out this field.
- School for '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Grade in '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Food allergies, Other Allergies, Other Medical Conditions REQUIRED Please fill out this field.
- Any special needs? REQUIRED Please fill out this field.
Child 5
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Child's Age REQUIRED Please fill out this field. Please enter valid data.
- Child's sex REQUIRED male female Please fill out this field.
- Name of CCD Parish of Catholic School Enrolled Last Year ('21-'22), if applicable REQUIRED Please fill out this field. Please enter valid data.
- Child HAS received the following sacraments (select ALL that apply) REQUIRED Baptism Reconciliation Communion Confirmation Has not received any sacraments yet Unsure Please fill out this field.
- School for '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Grade in '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Food allergies, Other Allergies, Other Medical Conditions REQUIRED Please fill out this field.
- Any special needs? REQUIRED Please fill out this field.
Child 6
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Child's Age REQUIRED Please fill out this field. Please enter valid data.
- Child's sex REQUIRED male female Please fill out this field.
- Name of CCD Parish of Catholic School Enrolled Last Year ('21-'22), if applicable REQUIRED Please fill out this field. Please enter valid data.
- Child HAS received the following sacraments (select ALL that apply) REQUIRED Baptism Reconciliation Communion Confirmation Has not received any sacraments yet Unsure Please fill out this field.
- School for '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Grade in '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Food allergies, Other Allergies, Other Medical Conditions REQUIRED Please fill out this field.
- Any special needs? REQUIRED Please fill out this field.
Child 7
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Child's Age REQUIRED Please fill out this field. Please enter valid data.
- Child's sex REQUIRED male female Please fill out this field.
- Name of CCD Parish of Catholic School Enrolled Last Year ('21-'22), if applicable REQUIRED Please fill out this field. Please enter valid data.
- Child HAS received the following sacraments (select ALL that apply) REQUIRED Baptism Reconciliation Communion Confirmation Has not received any sacraments yet Unsure Please fill out this field.
- School for '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Grade in '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Food allergies, Other Allergies, Other Medical Conditions REQUIRED Please fill out this field.
- Any special needs? REQUIRED Please fill out this field.
Child 8
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Child's Age REQUIRED Please fill out this field. Please enter valid data.
- Child's sex REQUIRED male female Please fill out this field.
- Name of CCD Parish of Catholic School Enrolled Last Year ('21-'22), if applicable REQUIRED Please fill out this field. Please enter valid data.
- Child HAS received the following sacraments (select ALL that apply) REQUIRED Baptism Reconciliation Communion Confirmation Has not received any sacraments yet Unsure Please fill out this field.
- School for '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Grade in '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Food allergies, Other Allergies, Other Medical Conditions REQUIRED Please fill out this field.
- Any special needs? REQUIRED Please fill out this field.
Child 9
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Child's Age REQUIRED Please fill out this field. Please enter valid data.
- Child's sex REQUIRED male female Please fill out this field.
- Name of CCD Parish of Catholic School Enrolled Last Year ('21-'22), if applicable REQUIRED Please fill out this field. Please enter valid data.
- Child HAS received the following sacraments (select ALL that apply) REQUIRED Baptism Reconciliation Communion Confirmation Has not received any sacraments yet Unsure Please fill out this field.
- School for '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Grade in '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Food allergies, Other Allergies, Other Medical Conditions REQUIRED Please fill out this field.
- Any special needs? REQUIRED Please fill out this field.
Child 10
- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Child's Age REQUIRED Please fill out this field. Please enter valid data.
- Child's sex REQUIRED male female Please fill out this field.
- Name of CCD Parish of Catholic School Enrolled Last Year ('21-'22), if applicable REQUIRED Please fill out this field. Please enter valid data.
- Child HAS received the following sacraments (select ALL that apply) REQUIRED Baptism Reconciliation Communion Confirmation Has not received any sacraments yet Unsure Please fill out this field.
- School for '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Grade in '22-'23 REQUIRED Please fill out this field. Please enter valid data.
- Food allergies, Other Allergies, Other Medical Conditions REQUIRED Please fill out this field.
- Any special needs? REQUIRED Please fill out this field.

Occasionally CCD children's pictures may be posted on the St. Michael's or the Our Lady Help of Christians website. Do you give permission for your child(ren)'s picture to be used? REQUIRED Yes you can use my child's picture No - do not use Please fill out this field.

Electronic Communication: The CCD program at Our Lady Help of Christians has many children enrolled. Therefore, most communication is conducted electronically (text/email). By checking below, you are agreeing to electronic communioication or stating that you will submit a letter expressing your desire for no electronic communication.

I Agree Please select this field.

Medical Emergency: I understand that reasonable precautions will be taken to safeguard the health and wellbeing of the participants in this Parish School of Religion program and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the Director of the Parish School of Religion, or associated colunteers of the Parish School of Religion program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that I, or other legal guardian(s), cannot be reached. I hereby do reliease and forever discharge this Diocese and Parish from all manner of actions or claims which I or the child named above shall or may have for any reason, arising during my child's attendance at the Parish School of Religion at Our Lady Help of Christians.

I Agree Please select this field.

Typed Name below constitutes a signature: REQUIRED Please fill out this field. Please enter valid data.

There is a $50.00 tuition fee. Tuition can be paid at the Our Lady Help of Christians parish office or on the first night of CCD classes.

If the tuition fee is a burden for your family,
please contact the St. Michael's parish office:
(240)681-3551

St. Michael Catholic Parish
& Mission of St. Dominic

Brandywine / Aquasco, MD

CCD Registration 2021-22 Form