CCS Pre-K Registration
(4 Year Old)
Student
*
First Name
Last Name
Student Is Enrolling In:
*
Half Day - Pre-K - Monday - Friday (9 a.m. - 12 p.m.)
Extended Day - Pre-K - Monday - Friday (9 a.m. - 3:30 p.m.)
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Place of Birth
Wheeling, WV
Other
Student's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Religion
Attending Parish
Baptism
-
Month
-
Day
Year
Date
Parish
Parish Name, City & State
Mother's Information
Mother
*
First Name
Last Name
Mother's Maiden Name
*
Date of Birth
*
-
Month
-
Day
Year
Date
Place of Birth
Wheeling, WV
Other
Address
Same As Student
Other
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Religion
Occupation
Place of Employment
Mother - Marital Status
Married
Separated
Divorced
Remarried
Widow
Father's Information
Father
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Place of Birth
Wheeling, WV
Other
Address
Same As Student
Other
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Religion
Occupation
Place of Employment
Father - Marital Status
Married
Separated
Divorced
Remarried
Widow
Siblings
Name
First Name
Last Name
Age
Name
First Name
Last Name
Age
Name
First Name
Last Name
Age
Name
First Name
Last Name
Age
If you were referred by one of our Corpus Christi Families, please list their name below.
Family Name
Registration Fee $100 (non-refundable)
Cash - Check - Credit or Debit Card
Registration Payment
Cash
Check
Credit or Debit
Submit
Should be Empty: