CCD Registration Form

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CCD Program Location 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.
- If your child wishes to be a CCD Teen Helper, please note in "additional information" section and also include if he/she received the Sacrament of Confirmation.
  Click here to review the CCD Teen Helper's Guidelines.
- For additional children:
- 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.
- 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 4 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. Please note if child carries an EPI-pen or other medications. Complete the following forms: "Parent Reuqest for Administration of Medication and Agreement of Release" and "Physician's Instructions concerning Medication Given at Parsh Religious Education Program" from the Diocese of Pittsburgh and return to Rachael Pratt at [email protected]
  - If child has a special diet & there is a special event/holiday celebration, please pack his/her own 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.
  - If you wish your child to receive a Sacrament (i.e. Frist Communion usually in grade 2 or Confirmation usually in grade 8) but he/she is in a higher school grade level, please note in "additional information" below.
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 Maximum 20 characters Please fill out this field. Please enter a phone number.
- Type REQUIRED Please fill out this field.
- Phone Number Maximum 20 characters 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 Maximum 20 characters 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 Maximum 20 characters Please enter a phone number.
- Relationship to child Please enter valid data.
- - If you have a custody arrangement that will affect your child/children's Religious Education (i.e. a specific parent is only allowed to pick-up child/children or there are specific weekends that child/children will not be able to attend CCD because staying with other parent), please note in "additional information" below and provide a copy of the custody arrangement/official court order to your Faith Formation Coordinator.
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.
Release
“In consideration for providing my child the opportunity to attend and/or participate in a Parish activity, sport, or event and any related transportation to and from the same, both my child and I voluntarily agree to waive, and discharge any and all claims against the Parish, its Governing Bodies, the individual members thereof, the Diocese of Pittsburgh, the Most Reverend David A. Zubik, Trustee, and all successors, assigns, officers, agents, employees, volunteers, and representatives and release them from liability for any exposure to or illness or injury from an infectious disease including COVID-19, including claims for any negligent actions of the Parish or its employees or agents, to the fullest extent allowed by law, for myself, my child, our estates, our heirs, our administrators, our executors, our assignees, and our successors .”
I Agree Please select this field.
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: CCD, 408 S Route 88, Carmichaels, PA 15320, OR give ONLINE (please select "Religious Education CCD"). Thank you.
CCD Donation Amount (Optional) $ Please enter a positive decimal.

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St. Matthias Parish

Greene County, PA

CCD Registration Form

St. Matthias Parish CCD Registration Form