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CCD Registration

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To register, either fill out the On-Line form below or download the .pdf form by clicking here ; fill out and submit to the Parish Office.
To pay the $30/individual or $50/family fee, use one of the following 3 methods.
– If you are unable to pay, please contact Coordinator, Sr. Alina Marie
– No Child Will be Kept From CCD Because Of An Inability To Pay

Please consider paying CCD Fees using this link to the On-line eGiving system.
Under the “One-time” section, use the “Fund” pull-down menu to select the appropriate CCD Fee fund (Individual or Family) and enter the appropriate amount in the “Amount” section, then follow the prompts to complete payment.
(Note: the amounts have been slightly adjusted to cover the eGiving fees incurred by the parish.)
Make a check payable to Blessed Sacrament Parish and note it is for CCD Fee. Bring to the Parish Office or drop in the collection basket.
Cash can be paid at the Parish Office.

CCD Registration Form

CAPTCHA
Student's Name*
First Middle Initial Last
Address*
Street Address Address Line 2 City State ZIP Code
Birthdate*
Gender*
- Male
- Female
Grade Entering*
School System*
Parish where your family is registered?*
Home Phone*
Student lives with*
- Parents/Grandparents
- Guardian(s)
Mother's Name*
First Last
Cell Phone (Mom)*
If none, enter (000) 000-0000
Mother's Religion*
Father's Name*
First Last
Cell Phone (Dad)*
If none, enter (000) 000-0000
Father's Religion*
Parent Email*
Onecall Number*
- Mom
- Dad
- Home
Indicate the phone # to be called for the parish Onecall Phone Messaging System
Parent can receive texts?*
- Yes
- No
Guardian's Name*
First Last
Guardian's Phone*
Gaurdian's Email*
Guardian's Address*
Street Address Address Line 2 City State ZIP Code
Sacraments
Sacraments Celebrated*
Please indicate which sacraments the child has received, appropriate questions will follow up
- Baptism
- Reconciliation
- Eucharist
- Confirmation
- None
Baptism*

Include Church and City, ST
Baptism Date*

Day
Month
Year

Month and Year required. If not sure of day, enter 01.
Reconciliation*

Include Church and City, ST
First Reconciliation Date*

Day
Month
Year

Month and Year required. If not sure of day, enter 01.
Eucharist*

Include Church and City, ST
First Eucharist Date*

Day
Month
Year

Month and Year required. If not sure of day, enter 01.
Confirmation*

Include Church and City, ST
Confirmation Date*

Day
Month
Year

Month and Year required. If not sure of day, enter 01.
Emergency Contact
If parents/guardians are unavailable
Emergency Contact (Non-parent/guardian)*
First Last
Contact Phone Number*
Contact Cell Phone Number
(If different from the other phone number)
Medical Consent granted for Parish to call provider and local hospital, if necessary*
- Yes
- No
In the event reasonable attempts to contact me are unsuccessful.
To Grant Consent
I hereby give consent for the following medical care provider’s and local hospital to be called:
Physician*
Phone*
Dentist*
Phone*
Preferred Hospital*
- Trumbull Regional Medical, 330-841-9011
- Akron Children’s Urgent Care, 330-856-8020
- St. Joe’s Mercy Health, 330-841-4000
In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by above-named doctors, or, in the event the designated practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to any reasonably accessible hospital.

Facts concerning the child’s medical history, including allergies, medications being taken, and any physical impairments to which a doctor should be alerted:
Allergies / Medical Conditions / Education Situations:
My child has an aide at school*
- Yes
- No
Please elaborate
Signature of Parent / Guardian*
Relationship to Student*

Please list your relationship to the student
Refusal To Consent
I do Not give my consent for the emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the Church authorities to take the following action:
Following action for no consent
Signature of Parent / Guardian*
Relationship to Student

Please list your relationship to the student
Become a Volunteer
Interest in volunteering for the Religious Education Program.
- Yes, I am interested
- No, sorry I am not interested
Name
First Last
Phone
Best contact phone number
Phone
This field is for validation purposes and should be left unchanged.

CCD Registration Form

CAPTCHA
Student's Name*
First Middle Initial Last
Address*
Street Address Address Line 2 City State ZIP Code
Birthdate*
Gender*
- Male
- Female
Grade Entering*
School System*
Parish where your family is registered?*
Home Phone*
Student lives with*
- Parents/Grandparents
- Guardian(s)
Mother's Name*
First Last
Cell Phone (Mom)*
If none, enter (000) 000-0000
Mother's Religion*
Father's Name*
First Last
Cell Phone (Dad)*
If none, enter (000) 000-0000
Father's Religion*
Parent Email*
Onecall Number*
- Mom
- Dad
- Home
Indicate the phone # to be called for the parish Onecall Phone Messaging System
Parent can receive texts?*
- Yes
- No
Guardian's Name*
First Last
Guardian's Phone*
Gaurdian's Email*
Guardian's Address*
Street Address Address Line 2 City State ZIP Code
Sacraments
Sacraments Celebrated*
Please indicate which sacraments the child has received, appropriate questions will follow up
- Baptism
- Reconciliation
- Eucharist
- Confirmation
- None
Baptism*

Include Church and City, ST
Baptism Date*

Day
Month
Year

Month and Year required. If not sure of day, enter 01.
Reconciliation*

Include Church and City, ST
First Reconciliation Date*

Day
Month
Year

Month and Year required. If not sure of day, enter 01.
Eucharist*

Include Church and City, ST
First Eucharist Date*

Day
Month
Year

Month and Year required. If not sure of day, enter 01.
Confirmation*

Include Church and City, ST
Confirmation Date*

Day
Month
Year

Month and Year required. If not sure of day, enter 01.
Emergency Contact
If parents/guardians are unavailable
Emergency Contact (Non-parent/guardian)*
First Last
Contact Phone Number*
Contact Cell Phone Number
(If different from the other phone number)
Medical Consent granted for Parish to call provider and local hospital, if necessary*
- Yes
- No
In the event reasonable attempts to contact me are unsuccessful.
To Grant Consent
I hereby give consent for the following medical care provider’s and local hospital to be called:
Physician*
Phone*
Dentist*
Phone*
Preferred Hospital*
- Trumbull Regional Medical, 330-841-9011
- Akron Children’s Urgent Care, 330-856-8020
- St. Joe’s Mercy Health, 330-841-4000
In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by above-named doctors, or, in the event the designated practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to any reasonably accessible hospital.

Facts concerning the child’s medical history, including allergies, medications being taken, and any physical impairments to which a doctor should be alerted:
Allergies / Medical Conditions / Education Situations:
My child has an aide at school*
- Yes
- No
Please elaborate
Signature of Parent / Guardian*
Relationship to Student*

Please list your relationship to the student
Refusal To Consent
I do Not give my consent for the emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the Church authorities to take the following action:
Following action for no consent
Signature of Parent / Guardian*
Relationship to Student

Please list your relationship to the student
Become a Volunteer
Interest in volunteering for the Religious Education Program.
- Yes, I am interested
- No, sorry I am not interested
Name
First Last
Phone
Best contact phone number
Comments
This field is for validation purposes and should be left unchanged.

St. Teresa of Calcutta Parish

3020 Reeves Rd NE
Warren, OH 44483 (330) 372-2215 Contact Us

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