Grade 1-5 Registration CCD Faith Formation "Let the little children come..."

My child will attend the CCD Program for (Select one) REQUIRED St Charles Borromeo - Grand Coteau Christ the King - Bellevue Please fill out this field.

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

Student First Name and Middle Initial REQUIRED Please fill out this field. Please enter valid data.

Student Birth Date (DD/MM/YYYY) REQUIRED Please fill out this field. Please enter valid data.

Check below which best applies to your child REQUIRED Last yr, my child attend the home taught CCD program at St. Charles Last yr, my child attended CCD at Christ the King - Religious Ed Center Last yr, my child did not participate in any CCD program Last yr, my child attended a Catholic School or CCD in another parish program (enter parish or Catholic School below) Please fill out this field.

(if applicable) name school or church parish here Please enter valid data.

Select Gender REQUIRED Male Female Please fill out this field.

Select Child's School Grade REQUIRED 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Please fill out this field.

Name of School your child attends Please enter valid data.

Select which program level you are registering your child REQUIRED 30 – CCD only 55 – CCD plus 1st Communion and 1st Confession Retreats 30 – ONLY 1st Communion and 1st Confession Retreats Please fill out this field.

Parental/ Guardian Contact Information

Primary Parent/Guardian's Full Name REQUIRED Please fill out this field. Please enter valid data.

Primary Mailing Address (Street, City, State, Zip) Please enter valid data.

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

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

List any other siblings attending the parish's religious education program Please enter valid data.

Backup Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

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

Does your child have any special circumstances or health needs such as allergies that we should be made aware of? If so, please note here

Saint Charles Borromeo

One family of faith
In service to God and to each other

Grade 1-5 Registration CCD Faith Formation
"Let the little children come..."