Religious Education Registration

CCD / CONFIRMATION

Address Information

Family Name

Required*

Mailing Address

Street 1*

Street 2

City*

State*

Zip*

Home Phone

Required* --

Head of Household

Last Name	Required*
First Name	Required*
Gender
E-mail	Required*
Religion	Required*
Marital Status	Required*
Cell Phone	Required*
Work Phone

Spouse/Other Adult

Last Name
First Name
Gender
E-mail
Religion
Marital Status
Cell Phone
Work Phone

Registration Offering:

Fees	1 child -- $25.00 2 children -- $45.00 Each additional child -- $15.00 (no one is turned away for inability to contribute) If you would like to pay online, you can go back to our homepage and click on the "Online Giving" icon on the ride-hand side. There is a fund, CCD/Confirmation Registration.

Dependents

Last Name

Required*

First

Required*

Middle

Special Needs

Gender

	Male
	Female

Date of Birth

Place of Birth: City, State, Country

Required*

Please be sure to separate with a comma.

Sacraments

Please check sacraments received and provide information.

Baptism
Required*

	Yes
	No

Baptism Date

Church of Baptism

City and State

Reconciliation/Confession
Required*

	Yes
	No

Holy Communion
Required*

	Yes
	No

Holy Communion Date

Church of Holy Communion

City and State

Attended CCD/Confirmation class last year
Required*

	Yes
	No

Grade Level

Required*

School Attending

Required*

Dependents

Last Name

First

Middle

Special Needs

Gender

	Male
	Female

Date of Birth

Place of Birth: City, State, Country

Please be sure to separate with a comma.

Sacraments

Please check sacraments received and provide information.

Baptism

	Yes
	No

Baptism Date

Church of Baptism

City and State

Reconciliation/Confession

	Yes
	No

Holy Communion

	Yes
	No

Holy Communion Date

Church of Holy Communion

City and State

Attended CCD/Confirmation class last year

	Yes
	No

Grade Level

School Attending

Dependents

Last Name

First

Middle

Special Needs

Gender

	Male
	Female

Date of Birth

Place of Birth: City, State, Country

Please be sure to separate with a comma.

Sacraments

Please check sacraments received and provide information.

Baptism

	Yes
	No

Baptism Date

Church of Baptism

City and State

Reconciliation/Confession

	Yes
	No

Holy Communion

	Yes
	No

Holy Communion Date

Church of Holy Communion

City and State

Attended CCD/Confirmation class last year

	Yes
	No

Grade Level

School Attending

Religious Education Registration

CCD / CONFIRMATION

Online Giving