CCD/PSR Registration (2022-2023)
St. Joseph the Worker Parish 229 California Ave. Weirton, WV 26062 Tel#: 304-723-2054 Email: joetheworkerdre@gmail.com
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Email *
Child's First & Last Name *
Date of Birth *
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Upcoming Grade Level (i.e., 1st, 2nd, etc.)  *
Student's Current Home Address *
Allergies/Medical Conditions *
Mother's Name (First, Middle, Last) *
Mother's Maiden Name *
Mother's Cell Phone #, Email Address, & Mailing Address (if different from above, otherwise, enter "same as the above") *
Father's Full Name *
Father's Cell Phone #, Email Address, & Mailing Address (if different from above, otherwise, enter "same as the above") *
Who does the child live with? *
If "Other," please explain, otherwise, enter "N/A" (not applicable) *
If student lives with one parent,  please indicate who has legal custody and/or if child also lives with stepparent. Otherwise, enter "N/A." *
Does this student have any medical or learning disabilities or food allergies? *
Is there anyone your child should not be picked up by? *
If "Yes" - by whom? If "No" - type N/A *
Name of Primary Contact (Parent/Legal Guardian) *
Primary Contact's Relation to Student *
Primary Contact's Cell Phone #, Email Address, & Mailing address *
Secondary Contact's Name, Relation to student, Phone Number, & Email (Optional)
Is child baptized? (If this student is being registered for the first time, please provide a Baptism certificate to the parish office) *
If yes, date of baptism
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DD
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Church where child was baptized (include city & state). *
Please check the other sacraments the student has received *
Required
Please indicate which of the choices below most accurately reflects your current faith practice as a family *
Required
Registration Fee ($30.00) - This helps cover the cost for texts, materials, food, etc. (Please drop off all cash and check payments to the Parish Office) *
Book Fee - Each book from Pre-K/K thru 6th Grade will be digitally available at no extra cost. However, if your child would like a hard copy, the cost will be approximately $30.00. More info on ordering procedures to follow via email, so stay tuned. If you're considering purchasing a hardcopy, simply bubble in your child's grade below. Otherwise, select N/A. 
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Checklist (Print, sign, & email to joetheworkerdre@gmail.com or drop off at parish office at 229 California Ave. Weirton, WV 26062) - You can also pick up and complete the forms at the Parish Office
Liability Waiver
Captionless Image
By entering my digital signature below (Parent's First and Last name), I agree to the conditions as outlined in the above Liability Waiver/Hold Harmless & Code of Conduct Forms. *
Photo Release Form
Photo Release Permission *
Photo Release Form Acknowledgement -  By entering my digital signature below (Parent's First and Last name), I agree to the conditions as outlined in the above Liability Waiver/Hold Harmless & Code of Conduct Forms. *
Touching Safety Opt-out Letter
By entering my digital signature below (Parent's First and Last name), I acknowledge that St. Joseph the Worker PSR/CCD program DOES NOT have my permission to present the Touching Safety program to my child whose name is (place a hypen or dash after the parent's name and enter the child's first and last name on the same line i.e. Joe Smith - Joe Smith Jr.) *
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