CCD Registration

Student Info

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

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

Student's Middle Name Please enter valid data.

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

School Grade REQUIRED Please fill out this field. Please enter an integer (number).

Street 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.

Family Info

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

Home Phone Number Please enter a phone number.

Mom's Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Dad's Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

School Attending (District/Building) REQUIRED Please fill out this field. Please enter valid data.

Parish to which family belongs REQUIRED Please fill out this field. Please enter valid data.

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

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

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

Maiden Name Please enter valid data.

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

Emergency Contact (Other than parent) REQUIRED Please fill out this field. Please enter valid data.

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

Relationship to child REQUIRED Please fill out this field. Please enter valid data.

Sacraments received by your child

Baptism REQUIRED Yes No Please fill out this field.

If yes, Date Please enter valid data.

Church/Location Please enter valid data.

First Communion REQUIRED Yes No Please fill out this field.

If yes, Date Please enter valid data.

Church/Location Please enter valid data.

Confirmation REQUIRED Yes No Please fill out this field.

If yes, Date Please enter valid data.

Church/Location Please enter valid data.

Health & Well-being information

Does your child have allergies? REQUIRED Yes No Please fill out this field.

If yes, please explain

Does your child have other medical conditions? REQUIRED Yes No Please fill out this field.

If yes, please explain

Are there any custody issues? REQUIRED Yes No Please fill out this field.

If yes, please explain and indicate the custodial parent

My child enjoys:

My child has difficulty with:

Anything else we need to know that will help us share the Good News with your child?

St Thomas the Apostle

Duquesne | Homestead | Munhall | West Mifflin | Whitaker

CCD Registration