Religious Education (CCD) 2021-2022

: Religious Education Enrollment Immaculate Conception Parish 2021-2022
Name
Parents/Guardians
Address
Phone Number
Email address
: Please list students youngest to oldest (Pre-K through 9th grades only) and give 2021-2022 grade levels.
Student #1 - Name, Grade, Date of Birth, City of Baptism
Student #2 - Name, Grade, Date of Birth, City of Baptism
Student #3 - Name, Grade, Date of Birth, City of Baptism
Student #4 - Name, Grade, Date of Birth, City of Baptism
: **New Students only: For any new student not baptized in our parish, we will need a photocopy of the baptismal certificate.**
: EMERGENCY CONTACT: Please give us a way to contact you in the event that your child becomes ill while at CCD.
Parent Contact Home Phone
Cell Phone
Other Contact (if we are unable to reach you) Name:
Relationship:
Phone Number(s):
: PAYMENT: (Please make checks out to : Immaculate Conception Church) Amount Due - $25 per child or $75 for 3 or more children per family. CCD classes begin Sunday, September 26, 2021.

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