Ministries - Youth Ministries - Vacation Church School - Registration

Vacation Church School Registration

Send To:
Presbytera Mia Tragus

* Required information
Student Name: *
Baptismal Name: *
Address: *
City: *
State: *       Zip Code: *
Home Phone: *
Email: *
Registration confirmation goes to this email.
Student's Email:
Student's Birth Date: *
Student's Age: *
Student's Grade Level this fall: *  
Father Name: *
Father Email: *
Father Work Phone: *
Father Cell Phone: *
Mother's Name: *
Mother's Email: *
Mother's Work Phone: *
Mother's Cell Phone: *
Emergency Contact's Name: *
Emergency Contact Relationship to Child: *
Emergency's Contact's Phone: *
What Parish are you a steward of? *

     Other Home Parish: (include parish name, city, and state)

Parent Volunteers Needed

Do you want to help with Vacation Church School?: *
Yes No

Please tell us if your child has any food allergies or any other medical conditions in the text box below.


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