St. John Vianney Church
CCD Registration
New Student Information
Use this form for a student who has NOT attented SJV CCD after September 2011

Register Returning Student

Please use proper upper/lower case for all fields.
Names will appear on class rosters, attendance sheets, etc. as entered here.

 
Family Name:
(Last Name Only!!)
        
Family Phone:
   (10 numeric digits)
      MUST BE THE SAME NUMBER USED ON FAMILY PAGE!!!
         
 Student information:  For Special Needs Student class on Sunday morning,
call Kim Stack at 410-535-4395 to register.
First Name:        Grade in School:    
Middle Name:        CCD Grade:    
Last Name:        Requested Session:    
Nick Name:   NOTE:
Grades K - 7 are Sunday Morning or Monday Night
              Grades 8 & 9 are only on Wednesday Night
        
Sex:       
Birthdate:
      mm/dd/yyyy
         
             
Primary Language:  
Student's E-mail and Cell Phone (the older students may have these) 
E-mail Address:       
Re-enter E-mail:        
Cell Phone:
(10 numeric digits)
      
As shown on Birth Certificate:
   Father's First Name  Last Name        
   Mother's First Name  Last Name        
Does student have a school IEP, LEP, SLP, or 504 plan?          
Learning disabilities or allergies:    (If not applicable, enter: None)    
                    Sacrement History
  Name of Church City, State Date (mm/dd/yyyy)
Baptism       
First Pennance       
First Communion       
Confirmation       

Please check your information before submitting.