2019 St. John Bosco Youth Day at Holy Hill
Saturday, October 5th, 2019 from 8:00am - 7:00pm

Drop off and pick up at St. James (W220N6588 Town Line Rd, Menomonee Falls, WI 53051)

Cost: $8 (includes lunch) PLEASE MAKE CHECKS PAYABLE TO "St. James"

Friends ALWAYS welcome!

Deadline for sign-up: October 2nd, 2019
Email address *
First Name *
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Last Name *
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Parish or Friend Of *
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PARENT/GUARDIAN FULL NAME *
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HOME ADDRESS *
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ALTERNATE EMAIL ADDRESS
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BEST PHONE TO CONTACT DURING EVENT *
Your answer
ALTERNATE PHONE *
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ALTERNATIVE CONTACT (If unable to reach you) *
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ALTERNATIVE CONTACT BEST PHONE DURING EVENT *
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PHYSICIAN'S FULL NAME *
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PHYSICIAN'S PHONE *
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NAME OF MEDICAL INSURANCE *
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MEDICAL INSURANCE POLICY NUMBER *
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PERTINENT MEDICAL CONDITIONS
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INHALER/EPI-PEN
ANY FOOD ALLERGIES TO BE AWARE OF?
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Would you like to chaperone? If so, how many youth can you drive in your vehicle, if needed?
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