Who is my Neighbor? Student Registration

Student's Name *

Birthdate *

Last School grade completed *

Address *

Medical concerns/allergies

Name of parent/primary caregiver *

Primary Phone (Cell) *

2nd phone

Emergency Contact (Name) *

Emergency Contact (Phone) *

Parent/Guardian Signature *

Please indicate which week your child will attend, considering their age: (No T-shirts will be ordered) *

June 5 through June 7, 2023 (Ages 4 and 5)

June 12 through June 14, 2023 (Ages 6 and 7)

June 19 through June 21, 2023 (Ages 8, 9, and 10)

June 26 through June 28, 2023 (Ages 11, 12 and 13)

NO FEES – IF YOU WISH, YOU MAY DONATE TO ST. JOHN THE EVANGELIST CHURCH to cover expenses.

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