"Dog Days of Summer" Trip to Mount Olympus 2018
Tuesday, August 14th, 2018 from 8:00am - 9:30pm

Drop off and pick up at Good Shepherd (N88W17658 Christman Road, Menomonee Falls, WI 53051)

Cost: $40 (includes lunch and dinner) PLEASE MAKE CHECKS PAYABLE TO "GOOD SHEPHERD"

Friends ALWAYS welcome!

Deadline for sign-up: August 7th, 2018

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 *
Your answer
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) *
Your answer
ALTERNATIVE CONTACT BEST PHONE DURING EVENT *
Your answer
PHYSICIAN'S FULL NAME *
Your answer
PHYSICIAN'S PHONE *
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NAME OF MEDICAL INSURANCE *
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MEDICAL INSURANCE POLICY NUMBER *
Your answer
PERTINENT MEDICAL CONDITIONS
Your answer
INHALER/EPI-PEN
ANY FOOD ALLERGIES TO BE AWARE OF?
Your answer
Would you like to chaperone? If so, how many youth can you drive in your vehicle, if needed?
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