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2021-2022 ICC CCE Registration & Information

- Immaculate Conception

CCE CALENDAR

ESPAÑOL - CCE INFORMACIÓN y REGISTRATION AQUI

NOTE: THIS PAGE IS FOR IMMACULATE CONCEPTION INDUSTRY. If you are registering for Sts Peter & Paul Bellville click here
ICC CCE / FAITH FORMATION REGISTRATION FORM
The maximum number of form submissions has been reached. This form is currently not available.
- Parent / Guardian 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Text? No Yes
  
  Religion Please enter valid data.
  
  Are you a registered parishioner? REQUIRED No Yes Please fill out this field.
  
  Preferred language REQUIRED Please fill out this field.
  
  Bilingual Spanish/English? No Yes
  
  WhatsApp No Yes
- Parent / Guardian 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Preferred language REQUIRED Please fill out this field.
  
  Address Same as Parent/Guardian 1 No Yes
  
  Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Religion Please enter valid data.
- Enter total # of Children you are registering: REQUIRED Please fill out this field.
  
  Child 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
  
  Attended CCE last year? REQUIRED No Yes Please fill out this field.
  
  Grade for 2021-2022 REQUIRED Please fill out this field.
  
  Please Check which Sacraments your Child has received REQUIRED Baptism First Communion Confirmation None Please fill out this field.
  
  If applicable, please note parish where sacraments were received. Please enter valid data.
  
  Accommodations, Support, Health, or Allergy Concerns? Maximum 150 characters
  Please list any health or classroom concerns for this child.
  Please enter valid data.
  
  Child 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
  
  Attended CCE last year? REQUIRED No Yes Please fill out this field.
  
  Grade for 2021-2022 REQUIRED Please fill out this field.
  
  Please Check which Sacraments your Child has received REQUIRED Baptism First Communion Confirmation None Please fill out this field.
  
  If applicable, please note parish where sacraments were received. Please enter valid data.
  
  Accommodations, Support, Health, or Allergy Concerns? Maximum 150 characters
  Please list any health or classroom concerns for this child.
  Please enter valid data.
  
  Child 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
  
  Attended CCE last year? REQUIRED No Yes Please fill out this field.
  
  Grade for 2021-2022 REQUIRED Please fill out this field.
  
  Please Check which Sacraments your Child has received REQUIRED Baptism First Communion Confirmation None Please fill out this field.
  
  If applicable, please note parish where sacraments were received. Please enter valid data.
  
  Accommodations, Support, Health, or Allergy Concerns? Maximum 150 characters
  Please list any health or classroom concerns for this child.
  Please enter valid data.
  
  Child 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
  
  Attended CCE last year? REQUIRED No Yes Please fill out this field.
  
  Grade for 2021-2022 REQUIRED Please fill out this field.
  
  Please Check which Sacraments your Child has received REQUIRED Baptism First Communion Confirmation None Please fill out this field.
  
  If applicable, please note parish where sacraments were received. Please enter valid data.
  
  Accommodations, Support, Health, or Allergy Concerns? Maximum 150 characters
  Please list any health or classroom concerns for this child.
  Please enter valid data.
- Emergency Contact (Not parents)
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Emergency Contact's Relation to Child(ren) REQUIRED Please fill out this field. Please enter valid data.
  
  Doctor's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Doctor's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Insurance Name REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Group Number REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Medical Consent:
  In the event of an emergency, I hereby give permission to the staff of Immaculate Conception (Industry) to seek emergency medical transport and/or treatment for my child(ren) named above. I will be responsible for all costs incurred. I wish to be advised before further care is given by the hospital or doctor.
  I Agree Please select this field.
- Video/Photography Consent
  As parent/guardian, I understand that promotional pictures and videos ( individual and group) may be taken during the classes and activities. I give permission for my child(ren)'s pictures (named above) to be used for church promotional materials such as newsletters, web pages, calendars, Power Point presentations, or videos to promote or highlight activities of the children in their Faith Formation classes.
  I Agree Please select this field.
- Consent and Liability Waver
  In the event of any accident or injury, I agree on behalf of myself, my child(ren)'s other parent if known or living, the child(ren) named above or our heirs, successors, and assigns, to hold harmless and defend the Archdiocese of Galveston-Houston, its pastor or any representative of Faith Formation and Youth Ministry, unless the parties involved were careless and negligent. Effective for all Faith Formation and Youth Ministry activities at Immaculate Conception (Industry)
  I Agree Please select this field.
- By registering your child(ren) for faith formation you give permission to the parish to provide its catechists with access to your child(ren) for the purpose of catechesis. Depending on the circumstances and the program, this access may be face-to-face in a parish facility, or may be on a virtual platform approved and overseen by the parish, or both. All catechists have been cleared by the Archdiocesan Office of Child and Youth Protection to work with minors and have completed all required safe environment training.
  I Agree Please select this field.
- Faith Formation Handbook
  I have read and agree to the policies of the Faith Formation Handbook (found here) for the child(ren) named above.
  I Agree Please select this field.
- Additional information: Please enter valid data.
- Parent / Guardian Electronic Signature REQUIRED Please fill out this field. Please enter valid data.
Submit

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SUBMISSION & PAYMENT INFORMATION

Clicking the PAYMENT BUTTON will open a new tab. You may submit this registration form first or click payment first. In either case, you will need to manually add your students cost together. Then on the ICC Payment (Giving) Page CHOOSE "CCE REGISTRATION" in the drop down menu to process your total payment there.

You may also bring check or cash payment to the Church Office, but Registration will not be processed until payment is complete.

Limited in-class spaces are first come, first served.

Parishioner Registration $35 per child
Non-Parishioner Registration $90 per child
Returning CCE Catechist $0
PAYMENT (Opens new page)

CCE PAYMENT

2021-2022 ICC CCE Registration & Information

NOTE: THIS PAGE IS FOR IMMACULATE CONCEPTION INDUSTRY. If you are registering for Sts Peter & Paul Bellville click here