Saint Bernadette Religious Education

Subtitle

 

Please print and complete BOTH sides                       Date ______________

Fee payable to St. Bernadette Religious Education, 245 Azalea Drive, Monroeville, PA 15146

Registered Parishioner1 child: $35.00   2  child $50.00    3 or more $75.00

Enclosed $________   Cash _____ Check #________Balance due_______

Family Name ________________________________________

Father's Name______________Mother'sName________________________

Registered in parish     Yes         No           Mother's Maiden Name_______  

Children live  with ________________________                                          

Street Address __________________________________

City ____________________________ Zip Code ___________________

Home Phone _______________Mom cell__________Dad cell___________                                           

Email________________________________________________________

In the event of an emergency, who else may be contacted?

Name_______________________Phone number_____________

Please list person or persons who will be dropping off or picking up children other than parents:

 ___________________________________________________________________

 Session choices:  1-8th grade  Check one

            Sunday morning- 9:00 - 10:30 a.m..____________

            Home Study -  please call CCD office __________

 (Please check if able to volunteer at any time during the coming term and list name of person volunteering)

Volunteers needed:   Catechist________________grade ______________

                                    CCD office help______________________

                                    Substitute Catechist________Grade ______

  Students enrolled in program:

1 Name  (first,middle,last)______________________________________ 

Male ____Female________     Date of Birth_______              

School grade for 2019/2020________CCD Grade for 2019/2020________      Has child been  Baptized     yes       no       

Church of Baptism_______________                                         

Has child received the Sacrament of Reconciliation?      yes      no                                                               Eucharist?       yes       no

 Special needs:  (Learning difficulties, allergies, physical or health needs/family circumstances)

 _________________________________________________________________________________________

2.  Name (first,middle,last)_____________________________________ 

Male ____Female________     Date of Birth_______________              

School grade for 2019/2020_______CCD Grade for 2019/2020__________ 

  Has child been  Baptized     yes       no      

Church of Baptism_______________                               

Has child received the Sacrament of Reconciliation?      yes     no                                                      Eucharist:       yes       no

 Special needs:  (Learning difficulties, allergies, physical or health needs/family circumstances)

 ____________________________________________________________________________________________

3.Name(first,middle,last)_________________________________________________

 Male ____Female________     Date of Birth_______________              

School grade for 2019/2020_______CCD Grade for 2019/2020 __________      Has child been  Baptized     yes       no     

Church of Baptism__________________________                                         Has child received the Sacrament of Reconciliation?     yes      no

                                                                                                                         Eucharist?    yes       no

  Special needs:  (Learning difficulties, allergies, physical or health needs/family circumstances)

 ____________________________________________________________________________________________

Picture Permission:

I give permission to have pictures taken of my child/children during CCD time._____________________

 I do not wish to have my child photographed at any time______________________________________

 

 

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