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:_________________________________________________