Totus Tuus Registration Form 2019
Totus Tuus for Sacred Heart & St. Augustine parishes will be held on the Sacred Heart Campus in Jeffersonville beginning on June 23, 2019 and ending on June 28, 2019. The group leader is Veronica Prechtel (812-284-3324).

Totus Tuus Program: Totus Tuus for grades 1-6 meets on Monday-Friday from 9am-2:30pm for classes, skits, lunch and recess. Totus Tuus for grades 7-12 meets on Sunday-Thursday from 7pm-9pm for classes, games, snacks, and activities in the Church.

The registration fee is $20 per child. After Care is available from 2:30pm-5:30pm for a fee of $20 per child.

Please complete this form as completely as possible. You will need to complete 1 form for each child you want to register. Veronica will contact you directly to coordinate collection of fees and required paperwork.

Thank you for choosing Totus Tuus for your family.
Student Information
Please answer all questions below about the first student you would like to register.
Name of Student
Your answer
Date of Birth
MM
/
DD
/
YYYY
What grade is this student entering the fall?
Your answer
What school do/will the student be attending?
Your answer
What t-shirt size does the student wear?
Will the student need after care?
Medical and Liability Information
Mother's Name (include Maiden name)
Your answer
Father's Name
Your answer
Child's Social Security Number (optional, but would be needed in the event of a medical emergency)
Your answer
Home Address
Your answer
Chronic Conditions (ie. epilepsy, diabetes)
Your answer
Allergies/Medications
Your answer
Anything else we should know about your child?
Your answer
Preferred parent or guardian contact phone number
Your answer
Preferred parent or guardian email address
Your answer
Emergency Contact Name and phone number
Your answer
Medical Insurance Company and Policy Number
Your answer
Medical Insurance Member's Name and phone number
Your answer
Family Doctor's name and phone number
Your answer
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