St. Genevieve Catholic Church

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Jesus In July Bible Camp 7/11-7/15/22

- Formation Ministries

You may download form and return or register below
- 2022 JESUS IN JULY BIBLE CAMP REGISTRATION FORM
The maximum number of form submissions has been reached. This form is currently not available.
- DEADLINE TO PRE-REGISTER IS:
  MAY 31, 2022
- **REGISTRATION STEPS**
  
  1--ONCE YOU SUBMIT THIS COMPLETED FORM FOR EACH CHILD BEING REGISTERED,
  2--USE THE PAYPAL BUTTON BELOW TO MAKE YOUR FEE PAYMENT(S).
- Number of children you will be registering? REQUIRED Please fill out this field.
- Child's Full Name (L, F, M) REQUIRED Please fill out this field. Please enter valid data.
- Grade entering next school session? REQUIRED Please fill out this field. Please enter valid data.
- School Attending? REQUIRED Please fill out this field. Please enter valid data.
- Church Parish of Registration REQUIRED Please fill out this field. Please enter valid data.
- T-Shirt Size REQUIRED Please fill out this field.
- Home Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Mailing address if different from above Please enter valid data.
- Father's Full Name (L, F, M) REQUIRED Please fill out this field. Please enter valid data.
- Mother's Full Name (L, F, M) REQUIRED Please fill out this field. Please enter valid data.
- Primary Contact Email REQUIRED Please fill out this field. Please enter an email address.
- Primary Phone # REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Father's Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Mother's Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Emergency Contact Other Than Parent-Full Name REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Phone Maximum 20 characters Please enter a phone number.
- Insurance Carrier, Group Name & Policy Number REQUIRED Please fill out this field. Please enter valid data.
- Family Physician REQUIRED Please fill out this field. Please enter valid data.
- Physician Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Special Needs: medical, allergies, learning disabilities, physical disabilities, etc.
- Medical Consent: I authorize a representative of St. Genevieve Church to seek medical attention for my child if I cannot be reached REQUIRED I Agree I Disagree Please fill out this field.
- Photo Consent: I authorize the use of any photos, videos or FaceBook Live video taken of/with my child during youth formation classes or events on all St. Genevieve social media platforms and publications. REQUIRED I Agree I Disagree Please fill out this field.
- Signature of Parent or Guardian: By my signature (printed name below), I agree that all the information given above is accurate and correct to the best of my ability. REQUIRED Please fill out this field. Please enter valid data.
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JESUS IN JULY REGISTRATION FEE PAYMENT
(If there is a financial hardship issue for payment of fee(s),
please contact Jessica Harvey @ 985-446-5127 for assistance.)