CCD Registration Form

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CCD Program Location REQUIRED Please fill out this field.
Homeschool CCD?
- I do NOT wish for my child/children to participate in CCD classes ONSITE. I will teach the CCD lessons provided by St. Matthias Parish at HOME. REQUIRED Yes NO, I wish for my child to attend CCD ONSITE if possible Please fill out this field.
Internet at Home? (if needed for CCD due to COVID-19) REQUIRED Please fill out this field.
Child's Information
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade Entering REQUIRED Please fill out this field. Please enter valid data.
- For additional child:
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Middle Name Please enter valid data.
- Gender
- Date of Birth Please enter a date.
- Grade Entering Please enter valid data.
- For 3 or more children, please submit another form as needed.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
- Medical Conditions / Food Allergies
- - There is NO nurse or medical personnel onsite during CCD.
  - If child has a special diet & there is a special event / holiday celebration, please pack his / her snack. Thank you.
Child's Sacraments
- Baptism: Location and Date
- First Communion: Location and Date
- ~ A copy of your child's Baptismal Certificate is required if NOT received at a Parish / Catholic Church in Greene County.
Parent / Guardian's Information
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Relationship to child if NOT parent (i.e. grandparent) Please enter valid data.
- Street REQUIRED Please fill out this field. 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.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Type REQUIRED Please fill out this field.
- Phone Number Please enter a phone number.
- Type
- Email REQUIRED Please fill out this field. Please enter an email address.
- Parent's Marital Status Married Separated Divorced Widow Single/Never Married Father Remarried Mother Remarried
- Father's Religion Please enter valid data.
- Mother's Religion Please enter valid data.
- Family will be registered as members of St. Matthias Parish,
  unless you note otherwise in "additional information" below
  your family's membership (i.e. St. Francis of Assisi).
Emergency Contact (if unable to reach parent)
- 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.
- Relationship to child REQUIRED Please fill out this field. Please enter valid data.
Person picking up child (if not parent)
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Phone Number Please enter a phone number.
- Relationship to child Please enter valid data.
Additional Information
Photo Release
- I give permission for my child/children to be photographed / video recorded and to use his/her name(s) in any printed or online publications by St. Matthias Parish and/or Pittsburgh Diocese. REQUIRED Yes No Please fill out this field.
Online Release
- I give permission for my child/children to participate in Zoom/Online classes by St. Matthias Parish. REQUIRED Yes No Please fill out this field.
Consent / Release
I understand that reasonable precautions will be taken to safeguard the health and well-being of the participants in the CCD programs of St. Matthias Parish and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the CCD staff, or other associated volunteers of the CCD programs to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself or other legal guardian(s) cannot be reached. I hereby do release and forever discharge the Pittsburgh Diocese and St. Matthias Parish from all manners of actions, claims which I or my child/children named above shall or may have for any reason, arising during my child’s/children’s attendance at these CCD.

I Agree Please select this field.
Diocese of Pittsburgh - COVID Memo ~ Parent's Signature REQUIRED
- Please print, sign & date, and return by September 20 to linettekerr@windstream.net or mail to St. Matthias Parish (see below for address ).
  
  Click here for CCD Homeschool ONLY.
  
  Click here for CCD onsite.
  **If you wish your child to participate in CCD onsite when available, please use sign the "CCD onsite" DioPitt COVID memo.
There is no registration fee, however, donations are greatly appreciated. Please make checks payable to St. Matthias CCD and mail to St. Matthias Parish, ATTN: Religious Education CCD, 232 E High St, Waynesburg, PA 15370 OR give ONLINE (please select "Religious Education CCD"). Thank you.
CCD Donation Amount (Optional) $ Please enter a positive decimal.

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