Catholic Church

10768 Dayton Pike
Soddy Daisy, Tennessee 37379
(423) 332-5300

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Registration Form

- Faith

VBS Child Registration
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- Child’s Name Please enter valid data.
- Child’s gender
- Child’s age Please enter an integer (number).
- Date of birth REQUIRED Please fill out this field. Please enter a date.
- Last School grade completed Please enter an integer (number).
- Name of parent Please enter valid data.
- Street Address 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.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Home Parish Please enter valid data.
- List any allergies, medical conditions, or special needs
- Emergency Contact Name Please enter valid data.
- Emergency Contact Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Emergency contact’s relationship to child Please enter valid data.
- Crew number or name (for church use only) Please enter valid data.
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