FOR RETURNING STUDENTS

RELIGIOUS EDUCATION REGISTRATION

Date: ____________

(We need the following information for permanent church record books. Please fill out entire form. Thank you.)

Student’s Last Name: _______________________________________

First Name: _______________________________________

Middle Name: _______________________________________

Nick Name: _______________________________________

Street Address: _______________________________________

City, Zip: _______________________________________

Telephone: _____________E-Mail Address_____________

Father/Guardian’s Name: _____________________________________

Father’s Address

(If Different From Student): __________________________________

Mother/Guardian’s Name: ____________________________________

Mother’s Address

(If Different From Student): __________________________________

Student’s Current Grade at School: ____________________________

Student’s Current Grade at CCD: ______________________________

In Case of Emergency Call: __________________________________

Telephone: __________________________________

Does Student have any Special Needs, Diet, Allergies, Disabilities?

(To register additional children in your family:)

Student’s Last Name:_______________________________________

First Name: _______________________________________

Middle Name: ______________________________________

Nick Name: _______________________________________

Student’s Current Grade at School: ____________________________

Student’s Current Grade at CCD: ______________________________

Does Student have any Special Needs, Diet, Allergies, Disabilities?

_________________________________________________________

(If necessary, use other side to register additional children)

OFFICE USE ONLY:

Registration Fee Amount: _______ Date Received: ________Cash/Check (Circle One) Check Number: ______

Please fill out other side first.

This side is to register additional students in your family.

Student’s Last Name:_______________________________________

First Name: _______________________________________

Middle Name: _______________________________________

Nick Name: _______________________________________

Student’s Current Grade at School: ____________________________

Student’s Current Grade at CCD: ______________________________

Does Student have any Special Needs, Diet, Allergies, Disabilities?

_________________________________________________________

Student’s Last Name:_______________________________________

First Name: _______________________________________

Middle Name: _______________________________________

Nick Name: _______________________________________

Student’s Current Grade at School: ____________________________

Student’s Current Grade at CCD: ______________________________

Does Student have any Special Needs, Diet, Allergies, Disabilities?

_________________________________________________________

Student’s Last Name:_______________________________________

First Name: _______________________________________

Middle Name: _______________________________________

Nick Name: _______________________________________

Student’s Current Grade at School: ____________________________

Student’s Current Grade at CCD: ______________________________

Does Student have any Special Needs, Diet, Allergies, Disabilities?

_________________________________________________________

Any additional comments? __________________________________________________________________________________________________________________

_________________________________________________________