St. John Vianney Church
Summer Programs Registration
Please use proper upper/lower case for all fields.
Names will appear on program rosters, attendance sheets, etc. as entered here.
 
First Name        
Last Name        
Nick Name   
Address 1    
Address 2  
City    
State      
Zip Code          
Gender        
Birthdate mm/dd/yyyy              
Grade in School          
Primary Language      
Shirt Size        
SJV Parishioner       
Parent/Guardian Full Name            
Relationship       
Home Phone    
(10 numeric digits)   
       
Father Cell         
Mother Cell         
Emergency Contact        
Emergency Phone            
E-mail Primary           
Re-enter E-mail Primary           
E-mail Secondary        
Requests    
 
Does child have a school IEP, LEP, SLP, or 504 plan?       
Learning disabilities or allergies:    (If not applicable, enter: None)    

Select Program(s)


               

               


Waiver
I hereby authorize the coach, director, building monitor or volunteer present at St. John Vianney Family Life Center to seek immediate medical treatment for my child listed above, if a medical emergency arises while on the way to, returning from, or during any practice, game or meet in which the team participates. I also authorize the attending physician to perform any emergency treatment necessary after the consultation with the coach if I cannot be reached.

Electronic Signature (Full Name)         

Assumption of Risk
The parent, guardian or custodian by executing this registration for and on behalf of the named participant represents and warrants that they are unaware of any physical or mental impediment that would or could cause injury or harm to the participant or to others by the said participant’s participation in the activities of the St. John Vianney Family Life Center. Due to the strenuous nature of some activities, the parent, guardian, or custodian is urged to consult a physician concerning the fitness of the participant to engage in activities prior to executing this registration. Since all activities present certain inherent and/or inadvertent risks and hazards, know and acknowledge by the undersigned, the parent, guardian or custodian, by their execution hereof, approve the participant’s participation and assume all liability incident to the said minor’s participation, except that liability, which is imposed by law on the Catholic Archdiocese of Washington, their employees, agents or volunteers.


Electronic Signature (Full Name)         
Please check your information before submitting..
If you stay on this page after Submit Player Registration, look for data field validation errors!!