Student Registration

- Formation

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- Student Name
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade Entering 2017-18 School Year REQUIRED Please fill out this field. Please enter valid data.
- Parent Name
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Parent Email REQUIRED Please fill out this field. Please enter an email address.
- Parent Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Emergency Contact
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Allergies or Medical Conditions
- Release of Liability
  I grant permission for my child to attend St. Anthony's Vacation Bible School. I hearby release & save harmless St. Anthony School and Parish, staff and volunteers from any and all liability for injuries, losses or other claims arising out of or the result from this program.
- I Agree to Release of Liability Please select this field.
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