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NAM CCD Registration

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The maximum number of form submissions has been reached. This form is currently not available.
- Last Name of Father of CCD student(s) REQUIRED Please fill out this field. Please enter valid data.
- First Name of Father of CCD student(s) REQUIRED Please fill out this field. Please enter valid data.
- Last Name of Mother of CCD student(s) REQUIRED Please fill out this field. Please enter valid data.
- First Name of Mother of CCD student(s) REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name of Mother of CCD student(s) REQUIRED
  (if same as last name just retype last name)
  Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Father's Cell Phone Number REQUIRED
  List none if no cell phone
  Please fill out this field. Please enter valid data.
- Mother's Cell Phone Number REQUIRED
  List none if no cell phone
  Please fill out this field. Please enter valid data.
- Land line phone number for family of CCD student(s) REQUIRED
  Type none if no landline
  Please fill out this field. Please enter valid data.
- Preferred cell phone number(s) to receive text messages about CCD REQUIRED Please fill out this field.
- Is your family Registered as members of North American Martyrs Parish REQUIRED Please fill out this field.
- If no, please provide the NAM Parish registered member Please enter valid data.
- Emergency Contact Name REQUIRED
  This person is to contacted case of emergency if all contact info has been used without successful contact to parent or guardian
  Please fill out this field. Please enter valid data.
- Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.
- Relationship of Emergency Contact to the CCD student(s) REQUIRED Please fill out this field. Please enter valid data.
- Do you consent for your child(ren)'s picture to be taken to promote CCD and Religious Education at NAM? REQUIRED Please fill out this field.
- Please indicate any family issues or special situations that the Religious Education Office would be in need of knowing to better ensure the safety and education of your child(ren). REQUIRED
  List none if no issue
  Please fill out this field.
- Name of CCD student #1 REQUIRED Please fill out this field. Please enter valid data.
- Grade of CCD student #1 REQUIRED Please fill out this field. Please enter valid data.
- School District of CCD student #1 REQUIRED Please fill out this field. Please enter valid data.
- Current school name of CCD student #1 REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth of CCD student #1 REQUIRED Please fill out this field. Please enter valid data.
- Date of Baptism of CCD Student #1 REQUIRED Please fill out this field. Please enter valid data.
- Name of church of Baptism of CCD student #1 REQUIRED Please fill out this field. Please enter valid data.
- Address of church of Baptism of CCD student #1 REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Received by CCD student #1 REQUIRED
  Check all the sacraments that the CCD student has already received. (you can check more than one)
  First Communion First Reconciliation Please fill out this field.
- Allergies or medical concerns of CCD student #1 REQUIRED
  List none if no issues
  Please fill out this field. Please enter valid data.
- Name of CCD student #2
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Grade of CCD student #2
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- School District of CCD student #2
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Current school name of CCD student #2
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Date of Birth of CCD student #2
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Date of Baptism of CCD Student #2 Please enter valid data.
- Name of church of Baptism of CCD student #2
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Address of church of Baptism of CCD student #2
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Sacraments Received by CCD student #2
  Check all the sacraments that the CCD student has already received. (you can check more than one)
  First Communion First Reconciliation
- Allergies or medical concerns of CCD student #2
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Name of CCD student #3
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Grade of CCD student #3
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- School District of CCD student #3
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Current school name of CCD student #3
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Date of Birth of CCD student #3
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Date of Baptism of CCD Student #3 Please enter valid data.
- Name of church of Baptism of CCD student #3
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Address of church of Baptism of CCD student #3
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Sacraments Received by CCD student #3
  Check all the sacraments that the CCD student has already received. (you can check more than one)
  First Communion First Reconciliation
- Allergies or medical concerns of CCD student #3
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Name of CCD student #4
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Grade of CCD student #4
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- School District of CCD student #4
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Current school name of CCD student #4
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Date of Birth of CCD student #4
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Date of Baptism of CCD Student #4 Please enter valid data.
- Name of church of Baptism of CCD student #4
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Address of church of Baptism of CCD student #4
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
- Sacraments Received by CCD student #4
  Check all the sacraments that the CCD student has already received. (you can check more than one)
  First Communion First Reconciliation
- Allergies or medical concerns of CCD student #4
  (complete these fields if registering multiple children from the same family)
  Please enter valid data.
Submit
IF NOT BAPTIZED AT NORTH AMERICAN MARTYRS OR ST. MICHAEL’S A COPY OF THE BAPTISMAL CERTIFICATE IS NEEDED

St. Bartholomew 111 Erhardt Drive Pittsburgh, PA 15235 Phone: 412-242-3374 Fax: 412-242-1488 melissa@stbartsparish.com	St. Bernadette 245 Azalea Drive Monroeville, PA 15146 Phone: 412-373-0050 parishoffice@stbpitt.com	Saint Gerard Majella 121 Dawn Drive Verona, PA 15147 Phone: 412-793-3333 saintgerardmajella@comcast.net
North American Martyrs 2526 Haymaker Road Monroeville PA 15146 Phone: 412-373-0330 namoffice10@gmail.com	St. Michael 750 Wall Avenue Pitcairn, PA 15140 Phone: 412-373-2610 stmikepitcairn@verizon.net	Saint Susanna 200 Stotler Road Penn Hills, PA 15235 Phone: 412-798-5596 Fax: 412-798-0479 saintsusannapennhills@gmail.com