CCD Registration Form

 
 
 
  • (F)=Father (M)=Mother (B)=Both
 
 
 
 
  • Registration after June 15th: One child: $115. Two children: $140. Three or more: $170. Late Registration after August 31st: One child: $165. Two children: $190. Three or more: $220
    Additional cost for First Penance, First Communion, & Confirmation events TBA in the fall.

    If your child is a new student this year and was not baptized at St. Bernadette,
    please provide a copy of his or her baptismal certificate.

    St. Bernadette Religious Education
    70 University Boulevard, East
    Silver Spring, MD 20901

    Questions?: 301-593-5104 / rbudd@stbernadetteschurch.org

 
 
 
 
 
 
 
 
 
 
  • VOLUNTEERING
    FOR THE RELIGIOUS EDUCATION PROGRAM

    Please check the volunteer positions you are interested in helping with:


  • Volunteer Child Protection Compliancy:

    All parish volunteers who will have significant contact with children are required to become compliant with the Archdiocesan Child Protection policy.

    Please check off your current status to help us in planning for collaboration amongst volunteers (your status will be confirmed by our parish Child Protection Compliance coordinator:


  • Publicity release
    Permission is hereby granted to St. Bernadette Church to use the voice/audio recordings, photographs, video, and quotations of children and volunteers who participate to assist in community awareness, educational efforts, and related public relations purposes. I hereby agree to release and hold harmless St. Bernadette Church, the Archdiocese of Washington and their agents, servants, and employees from any and all claims, demands, causes of action and/or liability of whatever kind or nature arising out of or connected to the use of said voice/audio recordings, photographs, videos, or quotations.
    I hereby waive any right to compensation, fee or royalty for myself, the participant/student or our successors, heirs, or assigns in connection with the production or use of the aforesaid materials

  • As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”).
    Liability Waiver: Checking the box below the waiver constitutes your signature.
    I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Saint Bernadette Parish its officers, directors, employees and agents, and the Archdiocese of Washington, its employees and agents, chaperons, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Archdiocese of Washington, its employees and agents and chaperons, or representative associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/diocese.
    *Check box
    MEDICAL MATTERS: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. (Of the following statements pertaining to medical matters, sign only those that are applicable.)
    Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers, contact:

  • Other Medical Treatment: In the event it comes to the attention of the parish, its officers, directors and agents, and the Archdiocese of Washington, chaperons, or representatives associated with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called collect (with phone charges reversed to myself).

  • Medications: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are as follows:  

 

Verification