CCD Registration Form 2026-27

Last day to register is September 25, 2026

Fill out the form carefully for registration. Call CCD Office for any questions at (928) 783-1324 or send email to ccdenglish1@outlook.com. You may pay in person during CCD office hours (Wednesday, Thursday & Friday from 5:30 to 8:00 p.m.) , starting July 1st, 2026 or you can pay online. When you submit this registration form, the system will route you to Immaculate Conception payment site where you will have the option to pay if you chose to do so. Please note that once you click Submit, your registration has been completed.
Student Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Birth Date

MonthDayYear
Gender
Grade Level in School during 2026-2027 school year
(First Holy Communion - child must be at least 7 years old by the first day of class and for Confirmation - child must be in the 8th grade or 13 years of age by the first day of class)
Select Program
Total Annual Tuition - Must be paid by December 3rd, 2026
Family E-mail
example@example.com
Secondary E-mail
example@example.com
Mother/Guardian's Name
Mother/Guardian's Mobile Number
Format: (000) 000-0000.
Father/Guardian's Name
Father/Guardian's Mobile Number
Format: (000) 000-0000.
Emergency Contact Name
Emer. Contact Relationship to Student
Emergency Contact's Mobile Number
Format: (000) 000-0000.
Quantity
Has the child been baptized?
If Yes, Please indicate name of parish and location.
Email copy of Baptism or Birth Certificate to ccdenglish1@outlook.com
Has the child received First Holy Communion?
If Yes, Please indicate name of parish and location.
Email copy of First Holy Communion Certificate to ccdenglish1@outlook.com
Name of Siblings in CCD Program. List name, grade and CCD program
Does your child currently have an Individualized Education Program (IEP), 504 Plan, or any other educational, developmental, medical, or learning needs that we should be aware of? Please provide any information you feel is important so that we can best support your child and ensure a positive experience.
Additional Comments. List any allergies we should be aware of. Also any special needs your student may have.
Name of Person Completing this Form
Relationship to Student
Copy of Baptism or First Holy Communion certificate may be uploaded here, sent via email to ccdenglish1@outlook.com or take copy in person. If child has not been baptized, copy of birth certificate is required.

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Last day to register is September 25, 2026