CCE Registration 2020-2021

Child's Full Name REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Which day and time do you wish your child to attend CCE virtually via Zoom? REQUIRED Tuesdays - 6:00 PM to 7:30 PM - (Elementary School 1st to 5th Grade only) Wednesdays - 7:00 PM to 8:30 PM - (Elementary School 1st to 5th Grade only) Saturdays - 9:00 AM to 10:30 AM - (Elementary School 1st to 5th Grade only) Sundays - 6:30 PM to 8:00 PM (Middle School & High School Only) Wednesdays - 7:00 PM to 8:30 PM (RCIA Only) Please fill out this field.

School Attending in 2020-2021 Please enter valid data.

2020-2021 Grade REQUIRED Please fill out this field. Please enter valid data.

Attended CCE last year in 2019 - 2020? Yes No

Which Parish did your child attend CCE in 2019 - 2020? Please enter valid data.

Child's City and State of Birth REQUIRED Please fill out this field. Please enter valid data.

Father's Name on Birth Certificate Please enter valid data.

Father is Baptized Yes No

Father's Religion? Please enter valid data.

Mother's Name on Birth Certificate Please enter valid data.

Mother is Baptized? Yes No

Mother's Religion? Please enter valid data.

Parents are Married? Yes No

Where were the parents married?

Name of siblings currently attending St. Justin CCE? Please enter valid data.

REGISTERING PARENT/GUARDIAN INFORMATION

Parent Full Name: REQUIRED Please fill out this field. Please enter valid data.

Email: REQUIRED Please fill out this field. Please enter an email address.

Home Phone Number Please enter a phone number.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Work Phone Number Please enter a phone number.

Address: Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Child lives with:

Medical Concerns, Learning challenges, Allergies? REQUIRED Please fill out this field. Please enter valid data.

SACRAMENTS COMPLETED

Baptism Yes No

Reconciliation Yes No

Eucharist Yes No

Confirmation Yes No

Date of Baptism Please enter a date.

Church Name Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Certificate of proof will be required for completed sacraments.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Names of children enrolled in CCE REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Cell Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Home Address REQUIRED Please fill out this field. Please enter valid data.

E-Sign of Parent (Full Name) REQUIRED Please fill out this field. Please enter valid data.

Parental Consent

I acknowledge that I have read and agree with the expectations and procedures listed in the St. Justin Martyr Religious Education Handbook. I agree to abide by all parent and student expectations, including attendance, homework, and behavior.

I acknowledge that I, as the parent, will attend a meeting with the Coordinator of Religious Education to discuss my child’s behavioral infractions, i.e., being disrespectful towards the teacher, students, not participating in class, etc.

I acknowledge that I have received and read the St. Justin Martyr Religious Education Handbook, via online at www.sjmtx.org.

Parent Name REQUIRED Please fill out this field. Please enter valid data.

Parent Signature REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

Technology Release

St. Justin Martyr must obtain written parental/guardian permission to communicate via social media or other electronic communications with students which are considered minors.

Parents will be notified of the method of communication which will be emails, social media (Facebook) and web-based instruction. These methods of communication will only be used for CCE Ministry purposes only.

Mode of Communication - Email, Social Media,
Web-Based Instruction

Parent Guardian Email REQUIRED Please fill out this field. Please enter an email address.

Parent Guardian Signature REQUIRED Please fill out this field. Please enter valid data.

Minor Child Email REQUIRED Please fill out this field. Please enter an email address.

Minor Child Signature REQUIRED Please fill out this field. Please enter valid data.

Photography/Video Consent

St. Justin Martyr, will take photos and/or videos during CCE and/or church life activities. By signing this, you are granting CCE Ministries to post photos and/or videos on our Website, Facebook page and/or CCE Newsletters of events. The photos and/or videos would be selected to highlight church activities (but not limited to), Sacraments, Retreats, CLOW, Vacation Bible School, etc. We will not reference your child by name or provide any specific information regarding your child. The photos and/or videos will only be used by St. Justin Martyr to show the many ways our children and youth flourish while participating in our Parish!

Please take a moment to let us know your preferences regarding our use of photos and/or videos of your children: REQUIRED Yes, I grant permission No, i do not grant permission Please fill out this field.

Child Name REQUIRED Please fill out this field. Please enter valid data.

Grade REQUIRED Please fill out this field. Please enter valid data.

Parent Signature REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

PICK-UP AUTHORIZATION FORM /EMERGENCY CONTACT (Minimum of 3)
MUST BE 18 OR OLDER

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Relation to Child REQUIRED Please fill out this field. Please enter valid data.