CCD Registration Form

Which Parish CCD are you registering for? St. Michael's Church St. Dominic's Church

Child's Full Name Please enter valid data.

Child's Date of Birth Please enter valid data.

Family Mailing Address

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

Father's Full Name Please enter valid data.

Mother's Full Name Please enter valid data.

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

Was child Baptized? Yes No

Date of Baptism Please enter valid data.

Parish of Baptism and City, State Please enter valid data.

Has child received First Holy Eucharist Yes No

Date of First Holy Eucharist? Please enter valid data.

Any health concerns / allergies?

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. Yes you can use my child's picture No - do not use

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