ST. THOMAS BECKET CHURCH

Please fill out a separate form for each child.

Each field requires an entry for successful registration.
If you don't have an e-mail address enter "none".


Student Name
Date of Birth
Gender (M/F)
Grade Entering
School
Parent/Guardian Names
Address
City
State
Zip
Home Phone
Work Phone
E-mail Address
Check each of the sacraments the child has received
Baptism (record must be on file before classes begin.) Penance Eucharist Confirmation
Emergency Contact Person and Phone #
Does your child have any special medical or educational needs that the teacher needs to be aware of? Other Comments
Please indicate if you are available to help as a Teacher, an Aide, Arts/Crafts, Office Work, Other.

Book fee per student is:
Early registration ( by June 30) = $35
July 1 or later = $60.
Please mail your check
(and baptism record if necessary)
to the church, attention: CCD.

Thank you for using our online registration.