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CCD Registration

CCD K-8th grade registration form

Please fill out completely this form to register your child(ren) for CCD classes. the first class begins August 25, 2021.

Parish

Parish you belong to

	All Saints - Holdrege
	St. John - Smithfield
	other

Parent Information

Father's Name

Required*

Father's Cell Phone

Required* --

Father's Email

Mother's Name

First Name*

Last Name*

Mother's Cell Phone

Required* --

Mother's E-mail

Family Address

Street 1*

Street 2

City*

State*

Zip*

I would be interested in helping

	Teaching CCD
	Substitute teacher
	Helping in the office

	Helping with special projects
	Classroom aide
	Playground monitor

Please call the office if your child will be gone from class. DO YOU WANT TO BE CALLED IF YOUR CHILD IS MISSING FROM CLASS?
Required*

	Yes-please call if my child is missing from class
	No-i dont need a call if my child is missing from class

Fees

the fee per each student is $25 for the year. ($10 book fee & $15 Diocese of Lincoln Education Fee). please make your payments to the office. write CCD in the check memo.

Student information

the fee per each student is $25 for the year. ($10 book fee & $15 Diocese of Lincoln Education Fee). please make your payments to the office. write CCD in the check memo.

1st STUDENT NAME

First Name

Middle Name

Last Name

Grade level in the fall

Does student have any special needs?

Sacraments received

	Baptism
	Eucharist

Confirmation

2nd Student information

STUDENT NAME

First Name

Middle Name

Last Name

Grade level in the fall

Does student have any special needs?

Sacraments received

	Baptism
	Eucharist

Confirmation

3rd Student information

STUDENT NAME

First Name

Middle Name

Last Name

Grade level in the fall

Does student have any special needs?

Sacraments received

	Baptism
	Eucharist

Confirmation

4th Student Information

STUDENT NAME

First Name

Middle Name

Last Name

Grade level in the fall

Does student have any special needs?

Sacraments received

	Baptism
	Eucharist

Confirmation

5th Student Information

STUDENT NAME

First Name

Middle Name

Last Name

Grade level in the fall

Does student have any special needs?

Sacraments received

	Baptism
	Eucharist

Confirmation

Fees

CCD FeesRequired* The CCD fee and Diocesan Education fee is per student, for all students. The Confirmation book fee is for those in 5th/6th/7th grades or any older student who has not yet received Confirmation. Confirmation classes are held monthly outside of CCD class times.

		Quantity	Extended

	Per student fee \| $10.00
	Diocese of Lincoln Education Fee \| $15.00
	Ssacrament of Confirmation fee \| $25.00

Order Summary

Subtotal
Discount
Sales Tax
Shipping & Handling
Total

Payment Type Invoice

Invoice How do you prefer to receive bills?
I prefer to receive bills by email.
I prefer to receive bills by postal mail.

Billing Contact Name
First Name*	Last Name*

Phone Required* -- Provide a contact phone number for the billing contact.

Email

Billing Address

Street 1*

Street 2

City*

State*

Zip*

Provide the billing address