summit registration - The Cathedral of the Most Sacred Heart of Jesus

REGISTRATION FORM/FORMULARIO DE REGISTRO

THIS IS OUR WEEKLY GROUP FOR 6-8TH GRADE STUDENTS/ESTE ES NUESTRO GRUPO SEMANAL PARA ESTUDIANTES DE 6° A 8° GRADO

Student Name/Nombre del estudiante(Required)

First Last

Address/Dirección(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Grade/Calificación(Required)

School/Escuela(Required)

Birthdate/Fecha de nacimiento

Parent Name/Nombre del padre(Required)

First Last

Parent Name/Nombre del padre

First Last

Primary Phone/Teléfono Principal(Required)

Email/Correo electrónico

Mother's Cell Phone/Celular de la Madre(Required)

Father's Cell Phone/Celular del Padre

Emergency Contact/Contacto de emergencia

First Last

Emergency Contact Phone/Teléfono de contacto de emergencia

Please list any special needs and/or allergies/Por favor enumere cualquier necesidad especial y/o alergias

Program Fees/Tarifas del programa

$30 For One Child

$50 For Two Or More

A link will be emailed to you to pay online or you may bring a check or cash.

Photo Release: I give permission for Sacred Heart Cathedral to take photos or video of my child during Summit and Summit-related activities to use in SHC sponsored media (i.e. bulletin, videos, newsletters, parish Facebook, SHC website, etc.)./Publicación de fotos: Doy permiso para que la Catedral del Sagrado Corazón tome fotos o videos de mi hijo durante Summit y actividades relacionadas con Summit para usar en los medios patrocinados por SHC (es decir, boletines, videos, boletines, Facebook parroquial, sitio web de SHC, etc.).(Required)

Yes

Phone

This field is for validation purposes and should be left unchanged.