Sacred Heart Parish Vacation Bible School Registration Form 2017
Dates: Sunday, June 25th thru Thursday, June 29th
Time: 9:30am - 11:30am
Location: Sacred Heart Gym
Cost: 1 Child - $55, 2 or more Children $100.00
If you are paying online with a credit card, please add $5 to your total for it's use.
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Gender
Child's Age *
Date of Birth *
MM
/
DD
/
YYYY
Last Completed School Grade *
Mother's Name *
Your answer
Father's Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Contact Phone Number *
Your answer
Contact Email Address *
Your answer
Home Parish *
Your answer
Please list any Allergies
Your answer
Please list any Dietary Needs
Your answer
Other Medical Conditions
Your answer
In case of an emergency contact/Relationship to child *
Your answer
Submit
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