Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. St Mary’s Class Spiritual Day When: December 13th 2025 Time: 11:00 am to 1:00 pm Location: St Mary’s Church Type of Registration *Please Select an OptionParticipantServantNext Display Current Date Parent's Name *FirstLastParent's Email *Parent's Phone Number *Number of Participants *1 Participant – $5.002 Participants – $10.003 Participants – $15.004 Participants – $20.005 Participants – $25.00 First participant Name *FirstLastAllergies * Second participant Name *FirstLastAllergies * Third participant Name *FirstLastAllergies * Fourth participant Name *FirstLastAllergies * Fifth participant Name *FirstLastAllergies *Sub-Total$0.00PreviousNextConsentParent / Guardian Name *Phone *Emergency Contact *Emergency Contact Phone *Insurance ProviderIndividual / Group #PARENT/GUARDIAN SIGNATURE REQUIRED FOR ENROLLMENT I hereby certify that my child (or I if I am over 18 years of age) is (am) willing and able to adhere to the event guidelines. If the church chaperones/servants decide that my child must leave early, one of the servants will reaching out to the parent via phone. In the event of an unforeseen incident or accident, I hereby declare that I will not hold liable the church as an organization, or the chaperones in their capacity as church representatives. I hereby certify that I give permission for the church / church representative to transport my kid(s) to the event and back to the church (if applicable). In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the church chaperones to hospitalize, secure proper treatment for, and to order injections, anesthesia or surgery for my child (or myself). I also give permission to the medical personnel selected by the church chaperones to order X-rays, routine tests, or treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for my child (or myself). I grant permission for my child to participate in every activity offered at the event. Display Current Date Consent *I agreeSignature * Clear Signature Servant's Name *FirstLastPhoneEmail * Phone Phone Layout Would you like to donate? *YesNoOptional DonationNextInvoice Order Summary Item Quantity Qty Total There are no products selected. Number of Participants – 1 Participant1$5.00Number of Participants – 2 Participants1$10.00Number of Participants – 3 Participants1$15.00Number of Participants – 4 Participants1$20.00Number of Participants – 5 Participants1$25.00Optional Donation1$0.00SubtotalTotal$5.00 $0.00Payment Information *PreviousSubmit
