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:_________________________________________________