Epiphany Parish CCD Religious Education Program Registration Form
Please complete one form for EACH child being registered.

All families registering for the first time, who's child(ren) were not baptized at Epiphany Parish, must provide a copy of the certificate of baptism from the church child(ren) were baptized.
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Email *
Child's Full Name (First, Middle, Last)
Child's Gender
Clear selection
Child's Date of Birth
MM
/
DD
/
YYYY
Child's Baptism took place in what church?
Date of Child's Baptism
MM
/
DD
/
YYYY
Child's First Holy Communion took place in what church?
Date of Child's First Holy Communion?
MM
/
DD
/
YYYY
Child's Current School District
Child's Grade for the upcoming school year
Clear selection
Father's Full Name
Mother's Full Name
Mother's Maiden Name
Child(ren) live with
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Street Address
City, State, Zip Code
Alternate Address
Alternate City, State, Zip, Code
Home Phone Number
Alternate phone number
Dad's Cell Phone
Mom's Cell Phone
Primary Email Address
Alternate Email Address
Parish Membership
If a member of Epiphany Parish, what is your collection envelope number?
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