St. Albert the Great School of Religious Education C.C.D. Registration Form 2014/2015 5535 West State Road-Burbank, IL 60459 708 636-0406 [email protected] Please Print Family Name _________________________________________________________________ Fathers Name _________________________________________________________________ Mothers Name ________________________________________________________________ Address _____________________________________________________________________ City ___________________________ State _______ Zip Code ________________ Home Phone ___________________ Cell ___________________ Cell __________________ Grades K through 5 Saturday Mornings 8:00-10:00 a.m. Grades 6 through 8 Wednesday Evenings 7:00-8:30 p.m. E-Mail Address ______________________________________________________________ Emergency Numbers (Must be different than the home phone number) FOR OFFICE USE ONLY Name ________________________________________ Phone _________________________ DATE RECEIVED _____________________ Name ________________________________________ Phone _________________________ TUITION _____________________________ Are you a registered contributing parishioner of St. Albert the Great SACRAMENT FEE _____________________ Yes No Registered Parishioner Tuition Fees One Child …………………. $250.00 Two Children ……………… $275.00 Three or More Children …….$300.00 Non Parishioner Tuition Fees One Child …………………. $300.00 Two Children ……………… $325.00 Three or More Children …….$350.00 Sacrament Fee Communion $35.00 includes retreat fee Confirmation $75.00 includes retreat fee Student Information Last Name 2014-15 First Name RM# CCD Grade Attended 2013-14 CCD Grade For 2014-15 Baptized YES NO VOLUNTEER HOURS __________________ FUND RAISING HOURS ________________ AMOUNT RECEIVED __________________ BALANCE DUE _______________________ Made 1st Reconciliation YES NO Made 1st Communion YES NO Made Confirmation YES NO ANY MEDICAL HISTORY WE SHOULD BE AWARE OF? ________________________________________________________________ ASTHMA ______________ MEDICATION CURRENTLY TAKING ____________________________________________________________ ALLERGIES __________________________________________________________________________________________________________ ANY LEARNING DISABILITIES WE SHOULD BE AWARE OF? ___________________________________________________________ L.D. _______________ A.D.D. _____________________ A.D.H. D. ____________________________________________________________ NOTE One full year of Religious Education is required prior to the reception of First Reconciliation and First Communion. Seven full years of Religious Education or it’s equivalent is required prior to the reception of Confirmation. Students who have missed Religious education for a year or more will be given an assessment test upon passing this assessment the student will be placed into his or her grade level class. If the student is assessed less than the grade level he or she should be in the student will be put into a class for one year to update him or her to where they need to be. The following year the student will be placed in the proper grade level. At this time the student will begin his or her two year preparation for the reception of the Sacraments. Parent or Guardian Signature _______________________________________________________________