EmailMe Form - CCD REGISTRATION

Today's Date *

MM / DD / YYYY

Please indicate whether new or returning student *

new CCD student

returning CCD student

Students who are new to our parish CCD program must complete the section on Sacramental Information

Please indicate at which campus you would like to attend CCD classes. *

St. Victor Campus (527 Bairdford Road, Bairdford PA)

Transfiguration Campus (94 McKrell Road, Russellton PA

Student Name *

First Middle Last

Date of Birth *

MM / DD / YYYY

Home Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Preferred Phone Number *

### - ### - ####

E-Mail Address *

Father's Name *

First Last

Father's Religion *

Mother's Maiden Name *

First Last

Mother's Religion *

Parent(s) Marital Status *

Emergency Contact Name *

First Last

Relationship to student *

Emergency Contact Phone Number *

### - ### - ####

STUDENT'S RELIGIOUS / EDUCATION BACKGROUND INFORMATION

Number of Years Attended *

Name / Place of CCD Program *

Name of school child will attend during the current school year *

Child's grade at the beginning of the current school year *

Do you have other family members enrolled in our CCD program *

Yes

No

Are you currently registered as a member of Our Lady of the Lakes Parish *

Yes

No

If you are not a member of Our Lady of the Lakes Parish, please indicate the name and location of the parish to which you belong.

STUDENT'S SACRAMENTAL INFORMATION

Please complete the Sacramental information section if a NEW student.

Date of Baptism

MM / DD / YYYY

Place of Baptism (name and address of church)

Date of First Eucharist

MM / DD / YYYY

Place of First Eucharist (name and address of church)

Date of Confirmation

MM / DD / YYYY

Place of Confirmation (name and address of church)

MEDICAL / OTHER INFORMATION

Please Note: the information regarding your child's particular needs will be kept confidential and only shared with the pastor, catechetical administrator, and the child's catechist.

Particular Learning Needs (Please share any information that may help us accomodate your child and his / her success in Faith Formation)

Health Challenges, Allergies, Medications, etc. (Please list and explain)

Other information you wish to share

Please indicate whether or not your child's photograph may be included on the parish website or in parish publications *

YES, you may use photos of my child in parish publications and / or on the parish website.

NO, please do not publish any photos of my child.

Individual and / or group photographs of CCD students may be taken during the school year for use in parish publications or on the parish website. These photographs may be taken during the course of CCD classroom and prayer activities, Masses, retreats, and other liturgical celebrations. Their purpose is to inform our parishioners as well as the local community as to the activities of our CCD program.

CCD FEE

One Child ---> $40.00
Two Children ---> $65.00
Three or more Children ---> $80.00

Please make all checks payable to Our Lady of the Lakes Parish. CCD fees may be mailed to or dropped off at the Parish Administrative Center located in the former St. Victor Rectory (527 Bairdford Road), or put in an envelope marked "CCD Fees" and placed in the collection basket at either St. Victor or Transfiguration Church.