CCD Registration

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

Grade This Fall REQUIRED Please fill out this field. Please enter valid data.

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

Place of Birth REQUIRED Please fill out this field. Please enter valid data.

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

Gender REQUIRED Male Female Please fill out this field.

Allergies or Medical Conditions

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

Street Address REQUIRED Please fill out this field. Please enter valid data.

City, State, & Zip REQUIRED Please fill out this field. Please enter valid data.

Primary Phone Number REQUIRED Please fill out this field. Please enter valid data.

Primary Phone Number REQUIRED Home Cell Please fill out this field.

Alternate Phone Number Please enter valid data.

Lives With: REQUIRED Mom Dad Both Other Please fill out this field.

If Other, Write Here Please enter valid data.

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

Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.

Religion REQUIRED Please fill out this field. Please enter valid data.

Mother/Guardian's Name Please enter valid data.

Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.

Religion REQUIRED Please fill out this field. Please enter valid data.

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

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.

Does student regularly attend Mass? REQUIRED Please fill out this field.

Sacrament Information

Students preparing for First Holy Communion or Confirmation must present a baptismal certificate.
Sacraments Received Baptism First Holy Communion Confirmation
Date and Church of each Sacrament REQUIRED Please fill out this field.

St. John Vianney