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CCD Registration Form

CCD Online Registration Form
- Click HERE to read the Media Authorization & Release Form. You may consent or decline permission when completing the registration form below.
  Please complete the registration form below. Click the Submit button to complete registration.
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Family Information
  
  Parish Envelope # Please enter valid data.
  
  Family Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Use the above address for correspondences? REQUIRED Yes No Please fill out this field.
  
  Father's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Religion Please enter valid data.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Mother's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email Please enter an email address.
  
  Religion Please enter valid data.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Preferred Parent Email REQUIRED Please fill out this field. Please enter an email address.
  
  I am aware that information will be sent via email. REQUIRED Yes No Please fill out this field.
  
  Step-parent (if applicable) Name, Religion, Phone Number, and Email
  
  Legal Guardian (if not a biological parent) Name, Religion, Phone Number, and Email
  
  If there is a person who may NOT HAVE ACCESS to child(ren), please provide their name and relationship. Please enter valid data.
  
  Order of Protection Exists? Yes No
  
  Emergency Contact Information
  
  Names of Two (2) Emergency Contacts, their phone numbers, and relationship to child(ren). REQUIRED Please fill out this field.
  
  Alternate Pick Up Contacts
  
  Please list below the names of three (3) additional persons who may pick up your child at dismissal should a parent/guardian not be able to be present.
  
  The people listed below MUST be ready to show ID in the event of the need to pick up your child. Your child(ren) will be released only to persons named below.
  
  Name, Phone Number, and Relationship to child(ren)
  
  Student Information
  
  Children REQUIRED Please fill out this field.
  
  Child 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Registration Type: REQUIRED Returning Student Transfer Student New Student Please fill out this field.
  
  This child has received the following sacraments: REQUIRED Baptism Reconciliation Communion Please fill out this field.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Public School attending in September 2024 REQUIRED Please fill out this field. Please enter valid data.
  
  Select the Grade attending REQUIRED Please fill out this field.
  
  Religious Education Grade for 2024-2025 - Please select the date you wish to attend REQUIRED Monday Wednesday Please fill out this field.
  
  Does your child have special learning needs or learning problems? REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical/Allergies/Additional Information REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Child 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Registration Type: REQUIRED Returning Student Transfer Student New Student Please fill out this field.
  
  This child has received the following sacraments: REQUIRED Baptism Reconciliation Communion Please fill out this field.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Public School attending in September 2024 REQUIRED Please fill out this field. Please enter valid data.
  
  Select the Grade attending REQUIRED Please fill out this field.
  
  Religious Education Grade for 2024-2025 - Please select the date you wish to attend REQUIRED Monday Wednesday Please fill out this field.
  
  Does your child have special learning needs or learning problems? REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical/Allergies/Additional Information REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Child 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Registration Type: REQUIRED Returning Student Transfer Student New Student Please fill out this field.
  
  This child has received the following sacraments: REQUIRED Baptism Reconciliation Communion Please fill out this field.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Public School attending in September 2024 REQUIRED Please fill out this field. Please enter valid data.
  
  Select the Grade attending REQUIRED Please fill out this field.
  
  Religious Education Grade for 2024-2025 - Please select the date you wish to attend REQUIRED Monday Wednesday Please fill out this field.
  
  Does your child have special learning needs or learning problems? REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical/Allergies/Additional Information REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Child 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Registration Type: REQUIRED Returning Student Transfer Student New Student Please fill out this field.
  
  This child has received the following sacraments: REQUIRED Baptism Reconciliation Communion Please fill out this field.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Public School attending in September 2024 REQUIRED Please fill out this field. Please enter valid data.
  
  Select the Grade attending REQUIRED Please fill out this field.
  
  Religious Education Grade for 2024-2025 - Please select the date you wish to attend REQUIRED Monday Wednesday Please fill out this field.
  
  Does your child have special learning needs or learning problems? REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical/Allergies/Additional Information REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Child 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Registration Type: REQUIRED Returning Student Transfer Student New Student Please fill out this field.
  
  This child has received the following sacraments: REQUIRED Baptism Reconciliation Communion Please fill out this field.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Public School attending in September 2024 REQUIRED Please fill out this field. Please enter valid data.
  
  Select the Grade attending REQUIRED Please fill out this field.
  
  Religious Education Grade for 2024-2025 - Please select the date you wish to attend REQUIRED Monday Wednesday Please fill out this field.
  
  Does your child have special learning needs or learning problems? REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical/Allergies/Additional Information REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Child 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Registration Type: REQUIRED Returning Student Transfer Student New Student Please fill out this field.
  
  This child has received the following sacraments: REQUIRED Baptism Reconciliation Communion Please fill out this field.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Public School attending in September 2024 REQUIRED Please fill out this field. Please enter valid data.
  
  Select the Grade attending REQUIRED Please fill out this field.
  
  Religious Education Grade for 2024-2025 - Please select the date you wish to attend REQUIRED Monday Wednesday Please fill out this field.
  
  Does your child have special learning needs or learning problems? REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical/Allergies/Additional Information REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Child 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Registration Type: REQUIRED Returning Student Transfer Student New Student Please fill out this field.
  
  This child has received the following sacraments: REQUIRED Baptism Reconciliation Communion Please fill out this field.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Public School attending in September 2024 REQUIRED Please fill out this field. Please enter valid data.
  
  Select the Grade attending REQUIRED Please fill out this field.
  
  Religious Education Grade for 2024-2025 - Please select the date you wish to attend REQUIRED Monday Wednesday Please fill out this field.
  
  Does your child have special learning needs or learning problems? REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical/Allergies/Additional Information REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Child 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Registration Type: REQUIRED Returning Student Transfer Student New Student Please fill out this field.
  
  This child has received the following sacraments: REQUIRED Baptism Reconciliation Communion Please fill out this field.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Public School attending in September 2024 REQUIRED Please fill out this field. Please enter valid data.
  
  Select the Grade attending REQUIRED Please fill out this field.
  
  Religious Education Grade for 2024-2025 - Please select the date you wish to attend REQUIRED Monday Wednesday Please fill out this field.
  
  Does your child have special learning needs or learning problems? REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical/Allergies/Additional Information REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Child 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Registration Type: REQUIRED Returning Student Transfer Student New Student Please fill out this field.
  
  This child has received the following sacraments: REQUIRED Baptism Reconciliation Communion Please fill out this field.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Public School attending in September 2024 REQUIRED Please fill out this field. Please enter valid data.
  
  Select the Grade attending REQUIRED Please fill out this field.
  
  Religious Education Grade for 2024-2025 - Please select the date you wish to attend REQUIRED Monday Wednesday Please fill out this field.
  
  Does your child have special learning needs or learning problems? REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical/Allergies/Additional Information REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Child 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Registration Type: REQUIRED Returning Student Transfer Student New Student Please fill out this field.
  
  This child has received the following sacraments: REQUIRED Baptism Reconciliation Communion Please fill out this field.
  
  Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Public School attending in September 2024 REQUIRED Please fill out this field. Please enter valid data.
  
  Select the Grade attending REQUIRED Please fill out this field.
  
  Religious Education Grade for 2024-2025 - Please select the date you wish to attend REQUIRED Monday Wednesday Please fill out this field.
  
  Does your child have special learning needs or learning problems? REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  Medical/Allergies/Additional Information REQUIRED Yes No Please fill out this field.
  
  If yes, please explain. Please enter valid data.
  
  I have read the Media Authorization and Release Form. REQUIRED Yes, I consent. No, I do not consent. Please fill out this field.
  
  When you click the Submit button below, your registration will be sent to the CCD Office.
  
  Submit
  
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St. Charles Church

Staten Island, NY

CCD Registration Form

CCD Online Registration Form

Student Information