Summer Programs Registration

Student Application

Thank you for applying for our summer programming! We are pleased to offer programming for grades Preschool through 12th grade. Please fill out the applications and indicate which program you are signing up for.

Student:

Name as appears on license (if applicable): REQUIRED Please fill out this field. Please enter valid data.

Cell Phone Number: REQUIRED Please fill out this field. Please enter valid data.

Email Address: REQUIRED Please fill out this field. Please enter valid data.

School: REQUIRED Please fill out this field. Please enter valid data.

Parish (if other than St. Patrick's) Please enter valid data.

Grade you will be entering in the fall of 2024: REQUIRED Please fill out this field. Please enter valid data.

Please list all food allergies or special dietary needs (vegetarians, vegans, etc.) as well as medical allergies and/or conditions of which we should be aware: REQUIRED Please fill out this field. Please enter valid data.

Medical Conditions REQUIRED Please fill out this field. Please enter valid data.

Physician Name REQUIRED Please fill out this field. Please enter valid data.

Physician Phone Number REQUIRED Please fill out this field. Please enter valid data.

Insurance Company REQUIRED Please fill out this field. Please enter valid data.

Insurance ID Number Please enter valid data.

Parents

Parent 1 Name: REQUIRED Please fill out this field. Please enter valid data.

Parent 1 Cell Phone: REQUIRED Please fill out this field. Please enter valid data.

Parent 2 Name: Please enter valid data.

Parent 2 Cell Phone: Please enter valid data.

Email Address: REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact and Phone Number: REQUIRED Please fill out this field. Please enter valid data.

T-shirt size REQUIRED Please fill out this field.

Please check what you are registering your child for: REQUIRED YIA Nashville, TN Volleyball League YIA Jr. Stellar VBS Please fill out this field.

If registering for Stellar VBS, are you willing to help somehow? There are many small jobs and other activities that need some help. More information and options will be available. Yes, with planning Yes, during the week No N/A

Payment options Pay electronically Send check in mail

Submit Application

By submitting this application, I understand the responsibilities and participation requirements involved in the St. Patrick’s Parish summer programming (i.e. YIA Nashville, YIA Jr and VBS).

After submitting the application, you can return to the Summer Programming Page to make any required payments electronically using the Online Giving button.

Summer Programs Registration

Documents

SUmmer programming