CCD Registration Form

Which Parish CCD are you registering for? REQUIRED St. Michael's Church St. Dominic's Church Please fill out this field.

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 School Grade Level REQUIRED Please fill out this field. Please enter valid data.

Family Mailing Address REQUIRED Please fill out this field.

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.

Emergency contact - Name and phone number REQUIRED Please fill out this field.

Father's Full Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Full Name REQUIRED Please fill out this field. Please enter valid data.

Who does the child reside with? Both parents Mother Father Other Relative / Guardian

Was child Baptized? REQUIRED Yes No Please fill out this field.

Date of Baptism REQUIRED Please fill out this field. Please enter valid data.

Parish of Baptism and City, State REQUIRED Please fill out this field. Please enter valid data.

Has child received First Holy Eucharist REQUIRED Yes No Please fill out this field.

Date of First Holy Eucharist? REQUIRED Please fill out this field. Please enter valid data.

Any health concerns / allergies? REQUIRED Please fill out this field.

Does your family have access to internet for email or possible homework assignments? REQUIRED Yes No Please fill out this field.

Occasionally CCD children's pictures may be posted on the parish website. Do you give permission for your childs picture to be used? If yes, you will receive a form once CCD starts requiring your signature for our files. REQUIRED Yes you can use my child's picture No - do not use Please fill out this field.

Tuition can be paid to the parish office or on the first night of CCD classes.

St. Michael Catholic Parish
& Mission of St. Dominic

Brandywine / Aquasco, MD

CCD Registration Form