Child Registration Form

- Faith Formation

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- Child 1 Name REQUIRED Please fill out this field. Please enter valid data.
- Child 1 Current Age REQUIRED Please fill out this field.
- Child 2 Name Please enter valid data.
- Child 2 Age
- Child 3 Name Please enter valid data.
- Child 3 Age
- Child 4 Name Please enter valid data.
- Child 4 Age
- Child 5 Name Please enter valid data.
- Child 5 Age
- Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
- Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Work Phone Number Maximum 20 characters Please enter a phone number.
- Cell Phone Number Maximum 20 characters Please enter a phone number.
- Allergies / Special Needs: Please indicate any allergies, especially food, or any other special needs. Indicate "none" if there are not any. REQUIRED Please fill out this field.
- Emergency Contact: In the event that parent/guardian cannot be reached, please contact: REQUIRED Please fill out this field. Please enter valid data.
- Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
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St. James parish

Washington, IA

Child Registration Form