Immaculate Heart of Mary/St. Joan of Arc
Vacation Bible School Registration Form
Monday, June 8th – Thursday June 11th 2020
Child’s Name:___________________________________ Gender: M/F
Age:______ Date of Birth:____/____/____ Last Grade Completed:_______
Child’s Name:___________________________________ Gender: M/F
Age:______ Date of Birth:____/____/____ Last Grade Completed:_______
Child’s Name:___________________________________ Gender: M/F
Age:______ Date of Birth:____/____/____ Last Grade Completed:_______
Parent’s/Guardian’s Names:____________________________________________
Address:___________________________________________________________
City:____________________________ State:__________ Zip:______
Home Telephone:_____________________ Cell:_____________________
Email Address:______________________________________________________
Home Parish:_______________________________________________________
Allergies or other medical conditions:____________________________________
__________________________________________________________________
Emergency Contact:__________________________________________________
Phone:_____________________________________________________________
Relationship to child:_________________________________________________