St. Philip the Apostle Church

ST. PHILIP THE APOSTLE CHURCH

Religious Education Office - 492 Saddle River Road Saddle Brook ,NJ 07663

TEL: 201-843-2240 EMAIL:

2015-2016 CCD REGISTRATION FORM

*Please print clearly*

Child’s Last Name ______Child’s First Name______

Street Address______City ______Zip Code ______

Home phone: ______

Grade which child will attend in Sept. 2015 ______School in Sept. 2015______

Father’s Name ______cell phone (______)______

Mother’s Name ______cell phone (______)______

Student lives with:______

E-mail address for Program Newsletters & Updates: ______

Note: Email address(es) are shared with your child’s catechist unless checked here ◻

Are you a registered member of St. Philip’s Parish? _____Yes ______No If Yes, Envelope # ______

Note: If you are not registered with St. Philip’s, please do so. Please call the Rectory at 201-843-1888.

Child’s Date and Place of Birth ______

______

Church of Baptism City/State Date

______

Church of First Holy Communion City/State Date

FOR FIRST TIME REGISTRATION OF SECOND THROUGH EIGHTH GRADE STUDENTS, PLEASE ATTACH A COPY OF THEIR BAPTISMAL CERTIFICATE ______attached

Release of Information: We need your permission to have your child's name published or photo taken in the event

their photo is published. If we do not have your permission, your child will not be included in the photo. At no

time will a child's last name be included in any photo. This permission slip will stay in your child's permanent folder.

My child may have their first name/photo published for school activities. ______Yes _____ No

Check Session Requested

Grades 1-6 (Sunday) : ______1st Session (after 8:30am Mass), _____ 2nd Session (after 10:00am Mass)

Grade 7th & 8th ( Monday 7to 8:30pm)

/
If paid before 6/30/15 / $100 / $140 / $180
If paid after 6/30/15 / $120 / $160 / $200

PLEASE MAKE CHECK PAYABLE TO: St. Philip the Apostle Religious Education. Kindly include payment with your

completed application. If you are unable to pay in full at time of registration, contact the DRE at 201-843-2240 for

installment plan arrangements.

IMPORTANT: Are there any learning disabilities or medical/allergies or other special needs that we should be aware of?

If yes, please describe:______

May we share this information in confidentiality with your child’s Catechist? _____Yes______No

In case of EMERGENCY call: Name ______

(Relationship to Student, if other than Parent or Guardian) Phone Number (____)______

Date: ______PARENT/GUARDIAN’S SIGNATURE ______

Paid: Y/N Payment: Cash ______Cash Receipt # ______Check ___ Check # ______Amt $ ______

Number of Children Registered: ______Date Registered: ______Balance Due: ______