PARENT/GUARDIAN NAME: _________________________________________________________

 CHILDS NAME: ________________________________________________AGE______Grade______

 CHILDS NAME: ________________________________________________AGE______Grade______

 CHILDS NAME: ________________________________________________AGE______Grade______

 ADDRESS: _____________________________________________________________________

                    _________________________________________________________________________

PHONE:  ___________________________E-MAIL ________________________________________

EMERGENCY CONTACT _______________________________PHONE: ______________________

ALLERGIES ________________________________________________________________________

OTHER MEDICAL CONDITIONS: _____________________________________________________

SIBLINGS 10 YEARS AND OLDER  WHO WOULD LIKE TO HELP:

NAME:   ______________________________________________________AGE ______Grade______

NAME:   ______________________________________________________AGE ______Grade______

                                                        

                                                           

REGISTRATION DEADLINE:  JULY 3, 2007.  SPACE IS LIMITED. 

Send Registration form to Immaculate Heart of Mary, 256 State Street , Granby , MA . 

Form can also be dropped in the Sunday collection basket.

413-467-3566