CCD Registration Form

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Family Information
Which session will they attend?*
St. Michael (8:15 - 9:15 AM Sunday Morning)
St. John (6:00 - 7:00 pm Tuesday Evening)
Home School (weekly)
- St. Michael, Canton
- St. John, Troy
- Home School
Address*
Street Address Address Line 2 City State ZIP Code
Father's Name*
First Last
Mother's Name*
First Maiden Last
Phone*
Email*
How many children do you want to register?*
Emergency Contact
Emergency Contact Name*
First Last
Emergency Contact Phone*
Relationship*
Child #1
Child's Name*
First Last
Date of Birth*
Grade Level*
Child #2
Child's Name*
First Last
Date of Birth*
Grade Level*
Child #3
Child's Name*
First Last
Date of Birth*
Grade Level*
Child #4
Child's Name*
First Last
Date of Birth*
Grade Level*
Additional Information
Any Additional Comments
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Phone
This field is for validation purposes and should be left unchanged.