School of Religion (CDC) Form

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

Gender REQUIRED Male Female Please fill out this field.

Name of School Attending REQUIRED Please fill out this field. Please enter valid data.

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

Is your child a Special Ed. Student? REQUIRED Yes No Please fill out this field.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Has the student received the Sacrament of Baptism REQUIRED Yes No Please fill out this field.

If yes, what church: Please enter valid data.

Date Please enter a date.

Has the student received the Sacrament of First Communion? REQUIRED Yes No Please fill out this field.

Has the student attended CCD Classes before? REQUIRED Yes No Please fill out this field.

If yes, what church: Please enter valid data.

Date Please enter a date.

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

Father's Religion REQUIRED Please fill out this field. Please enter valid data.

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

Mother's Religion REQUIRED Please fill out this field. Please enter valid data.

Guardian's Name (if applicable) Please enter valid data.

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

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

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

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

Emergency Contact Please enter valid data.

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

Are parents/guardians registered in this Parish? REQUIRED Yes No Please fill out this field.

Envelope # Please enter valid data.

If the child lives with someone other than the natural parents, or if there are other special circumstances, or if your child has any special medical conditions, please describe: Please enter valid data.

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

Brother/Sister in School Please enter valid data.

Grade Please enter valid data.

Brother/Sister in School Please enter valid data.

Grade Please enter valid data.

Brother/Sister in School Please enter valid data.

Grade Please enter valid data.

Most Pure Heart of Mary Church

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School of Religion (CDC) Form