St. Anthony Parish CCD Registration Form

SAINT ANTHONY OF PADUA CATHOLIC CHURCH

CCD Faith Formation Registration Form
CCD School Year
CCD Level

1st Year2nd YearContinuing Education
Note: All CCD Registrants must submit a copy of the Baptismal Certificate. Registration Fee: Donation of $25 per child
STUDENT'S FULL NAME*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Age*
School
Current Grade*
Address*
Mailing Address
Student Email Address
example@example.com
BAPTISM
Is you Child baptized?*

YesNo
Copy of Baptismal Certificate

Cancelof
Baptism Date

MonthDayYear
Date
Parish & Place of Baptism
PREVIOUS CCD CLASS
Did your child attend a previous CCD Class?

YesNo
If Yes, where
Year(s)
ALLERGIES OR AILMENTS
List any allergies or ailments:
FATHER'S INFO
Father's Name

First NameLast Name
Father's Religion
Father's Email Address
example@example.com
Father's Occupation
Father's Contact Number
MOTHER'S INFO
Mother's Name

First NameLast Name
Mother's Religion
Mother's Email Address
example@example.com
Mother's Occupation
Mother's Contact Number
EMERGENCY CONTACT INFO
EMERGENCY CONTACT
Relationship to the Student
Emergency Contact Number
I, the parent/guardian of ("My Child"), hereby grant Saint Anthony Catholic Church (Parish) and/or the Archdiocese of Agaña (Archdiocese) and their agents the absolute right and permission to use photographic portraits, pictures, digital images or videos of My Child, or in which My Child may be included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but not limited to use in any Parish or Archdiocese publication or on the Parish or Archdiocese websites or social media pages, without payment or any other consideration.

I hereby waive any right that may have to inspect and/o approve the finished product or the copy that may be used in connection therewith, wherein My Child's likeness appears, or the use to which it may be applied.

I hereby release, discharge, and agree to indemnify and hold harmless the Parish or Archdiocese and their agents from all claims, demands, and causes of action that I or My Child have or may have by reason of this authorization or use of My Child's photographic portraits, pictures, digital images or videos, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said images or videos, or in processing tending towards the completion of the finished product, including publication on the Internet, in brochures, or any other advertisements or promotional materials.

I represent that am at least eighteen (18) years of age and am fully competent to sign this Release.
Parent's Name*
Parent's Email Address*
example@example.com
Relation to the Student*
Parent's Signature*

Clear
CCD Online Registration Payment

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SAINT ANTHONY OF PADUA CATHOLIC CHURCH

BAPTISM

PREVIOUS CCD CLASS

ALLERGIES OR AILMENTS

FATHER'S INFO

MOTHER'S INFO

EMERGENCY CONTACT INFO