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RE Form

- Religious ED

2022-2023 Registrations are Now Opened!

Registrations for the 2022-2023 school year are now opened!
Required: 1 form per child.
The family must be registered Parishioners (to register click here).

If payment is not possible at this time contact Rose at religioused@mountvirgin.com to make payment arrangements
Religious Education Registration Form
The maximum number of form submissions has been reached. This form is currently not available.
- 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.
- Address 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.
- Birth Date REQUIRED Please fill out this field. Please enter valid data.
- Place of Birth REQUIRED Please fill out this field. Please enter valid data.
- School/CCD grade REQUIRED Please fill out this field.
- Father'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.
- Religion Please enter valid data.
- Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
- Work Phone Number Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Occupation
- Mother'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.
- Maiden Name Please enter valid data.
- Religion Please enter valid data.
- Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
- Work Phone Number Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Occupation
- Emergency Contact
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Relation 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.
- Child's Baptism
- Date REQUIRED Please fill out this field. Please enter a date.
- Church 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's First Reconciliation
- Date Please enter a date.
- Church Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Child's First Eucharist
- Date Please enter a date.
- Church Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Special Notes For Catechist(Medical/Food Allergies)
  Please add any notes that the catechist teaching your child needs to know (e.g. medications, allergies, special learning needs)
- Please note that there is no Nurse or medical personnel onsite during CCD
  If your child has a special diet & there is a special event/holiday celebration, please pack them a snack.
  I acknowledge Please select this field.
- Is your child is in 3rd grade or higher and has NOT received the Sacrament of Baptism, Reconciliation and First Eucharist? Please indicate this here and let your child’s teacher know. REQUIRED Please fill out this field.
- 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 Our Lady of Mount Virgin Parish and/or the Newark Diocese. REQUIRED Yes No Please fill out this field.
- Online Release: I give permission for my child/children to participate in Online classes by Our Lady of Mount Virgin Parish. REQUIRED Yes No Please fill out this field.
- Mass Attendance
  I will, to the best of my ability, ensure that my child will attend 11:30 AM Sunday Mass on a weekly basis. Please select 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 Our Lady of Mount Virgin 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 Newark Diocese and Our Lady of Mount Virgin 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.
- Tuition100.0
Total:

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