Summer Camp Registration – Saint John the Beloved Academy

1Student Info

2Mother Info

3Father Info

4Authorizations

5Emergency Contacts

6Consent

Mother/Female Guardian

Mother/ Female Guardian Name*

First Last

Marital Status*

Maiden Name*

Proof of Custody*

If divorced appropriate custody paperwork MUST be uploaded.

Max. file size: 50 MB.

Home Address*

Same as student

Street Address City State ZIP Code

Personal Email*

Home Phone*

Cell Phone*

Occupation*

Employer

Work Phone*

Work Email*

Work Address*

Street Address Address Line 2 City State ZIP Code

Father/Male Guardian

Father/Male Guardian Name*