A donation of $10 per student is requested to help defray costs.

Please complete 1 form per family and fill in as many children as applicable. If additional children, please fill out a second registration form.

Child 1 Full Name:

Child 2 Full Name:

Child 3 Full Name:

Child 4 Full Name:

Parents or Guardians' Names:

Street Address:

City, State, Zip:

Home Phone:

Cell Phone:

Email:

Number of family memers participating in Rome:

Person to contact in emergency if parents/guardians not available. Please provide name, address and phone:

Allergies or other medical conditions:

Comments or Questions:

Home Church: