Visitation of the Blessed Virgin Mary Parish

CCD Religious Education Registration

Please enter your student's information on this form and click the SUBMIT button when the form is completed. All fields are required. If a student has no allergies, please enter "none".

Note that registration is not complete until the registration fee is paid.

Student's Full Name:
Registration Type:	NEW REGISTRATIONINFORMATION UPDATE
Parent/Guardian Full Name:
Street:
City:
State:
ZIP:
Home Phone:
Emergency Phone:
Email:
Student Date of Birth:
Student's Place of Birth:
Student's Grade Level:	1st2nd3rd4th5th6th7th8th9th10th11th12th
Student's School:
Student's Year of Baptism:
Student's Parish of Baptism:
Student's Known Allergies: