CCD Program Registration

Please fill out the Registration Form below:

Parent/Legal Guardian 1

Name(Required)

First Last

Relationship to Student(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Legal Guardian 2

Name(Required)

First Last

Relationship to Student(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Emergency Contact Information

Is your family registered at Jesus the Good Shepherd?(Required)

If you are registered elsewhere, where are you registered?

Child 1 Information

Name(Required)

First Last

Birth Date (mm/dd/yyyy)

Gender(Required)

School(Required)

Grade(Required)

Primarily lives with(Required)

Has your child received the Sacrament of Baptism?(Required)

If yes, please list Church Name, City and State

Has your child completed 1st Reconciliation?(Required)

If yes, please list Church Name, City and State.

Has your child received First Holy Communion?(Required)

If yes, please list Church Name, City and State.

Please explain if there are any medical or educational situations that should be brought to our attention (allergies, gifted, special learning style, learning disability, etc.) for this child

Social Media Disclaimer Our Faith Formation program may take photographs and/or videos of students; these photographs and/or videos document learning and activities of the students. Please be advised we will contact you before posting any photographs and/or videos on our website or social media.

Social Media Disclaimer

I acknowledge the above statement

Our Faith Formation program may take photographs and/or videos of students; these photographs and/or videos document learning and activities of the students. Please be advised we will contact you before posting any photographs and/or videos on our website or social media.