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Dragon Hearts Registration

- 2022-2023 Dragon Hearts Registration
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Parent Information:
  
  Mom/Guardian First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mom/Guardian Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mom/Guardian Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Mom/Guardian Email REQUIRED Please fill out this field. Please enter an email address.
  
  Dad/Guardian First Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Dad/Guardian Last Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Dad/Guardian Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Dad/Guardian Email: Please enter an email address.
  
  Daughter(s) Full Mailing Address:
  
  Street Address REQUIRED Please fill out this field. 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.
  
  Emergency Info & Photo Release:
  
  Emergency Contact Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Phone Number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Daughter's Doctor's Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Daughter's Doctor's Phone Number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Daughter(s) may be picked up by:
  List any and all adults your daughter(s) can be picked up from events by. Separate names by commas
  Please enter valid data.
  
  Video/Photo/Audio/Media Release
  By typing my name below, I, (parent/guardian), hereby grant and authorize St. George Catholic Church Parish the right to take, edit, alter, copy, exhibit, publish, distribute, and make use of any and all pictures or video taken of my child(ren) named in this Dragon Hearts Registration Fprm, to be used in and/or for promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits, submissions to journalists, websites, social networking sites, and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats, and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing.
  I understand and agree that these materials shall become the property of the St. George Catholic Church Parish and will not be returned.
  I hereby hold harmless, and release St. George Catholic Church Parish from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.
  
  Parent/Guardian Name: REQUIRED
  Type your name in this field to give St. George Catholic Church permission to use media in the way stated in the above paragraph. If you do *not* give permission, type "No release given."
  Please fill out this field. Please enter valid data.
  
  Daughter #1 Information:
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Any allergies or health concerns we should be aware of? REQUIRED Please fill out this field.
  
  Grade Level for 2022-2023 School Year REQUIRED Please fill out this field.
  
  Birthday Month: REQUIRED Please fill out this field.
  
  Select which, if any, your daughter attends: REQUIRED Please fill out this field.
  
  If you selected 'other' above, please tell us what school your daughter attends: Please enter valid data.
  
  Daughter #2 Information:
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Any allergies or health concerns we should be aware of?
  
  Grade Level for 2022-2023 School Year
  
  Birthday Month:
  
  Select which, if any, your daughter attends:
  
  If you selected 'other' above, please tell us what school your daughter attends: Please enter valid data.
  
  Daughter #3 Information:
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Any allergies or health concerns we should be aware of?
  
  Grade Level for 2022-2023 School Year
  
  Birthday Month:
  
  Select which, if any, your daughter attends:
  
  If you selected 'other' above, please tell us what school your daughter attends: Please enter valid data.
  
  Are you available to help for some of your daughter's after school monthly meetings from 2:30-4pm? Meeting Helper Orientation will be in August where grade level meeting dates will be chosen. All meeting information and materials will be provided. After Orientation, a SignUp Genius will go out to sign up for specific meeting dates after dates chosen. Thank you! We can’t have meetings without your help.
  
  Are you available to help for some meetings? REQUIRED Yes No, not at this time Maybe Please fill out this field.
  
  Dragon Hearts Registration Fee REQUIRED Please fill out this field.
  
  Total:
  
  Submit
  
  Proceed to Payment
  
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- Links
  
  Dragon Hearts Webpage

Dragon Hearts Registration

Parent Information:

Daughter(s) Full Mailing Address:

Emergency Info & Photo Release:

Daughter #1 Information:

Daughter #2 Information:

Daughter #3 Information: