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The Challenge Club of Saint James, Registration Form 2021-2022
Please submit a separate registration form for each daughter. If you have questions, please contact the Club Registrar, Laura Svensson, at:
lmrsvensson@gmail.com
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* Indicates required question
Daughter's First Name
*
Your answer
Daughter's Last Name
*
Your answer
Age
*
Your answer
Grade
*
Your answer
Birthday (please be sure the birth year is correct)
*
MM
/
DD
/
YYYY
T-Shirt Size
*
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XLarge
Street Address
*
Your answer
City/Town
*
Your answer
Zip Code
*
Your answer
School Name
*
Your answer
Parish Name & Location
*
Your answer
Mom's First & Last Name
*
Your answer
Mom's Mobile Phone Number
*
Your answer
Dad's First and Last Name
*
Your answer
Dad's Mobile Phone Number
*
Your answer
Home Phone Number
Your answer
Parent Email Address(es) for Club Communication
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Emergency Contact Relationship to Girl
*
Your answer
Daughter's Allergies (if none, write "None")
*
Your answer
By checking the box below, you grant permission for your above mentioned daughter to participate in Challenge Club activities.
*
Participation Permission Granted
Required
Name of Parent Granting Participation Permission
*
Your answer
By checking the box below, you grant permission for pictures of your above mentioned daughter to be used for publicity purposes in news releases (no names will be mentioned).
*
Photo Release Granted
Required
Name of Parent Granting Photo Release
*
Your answer
Today's Date
*
MM
/
DD
/
YYYY
The annual membership fees are below. Please check the fee that applies to this registration. Please submit a separate registration form for each daughter. However, you may write a single check covering siblings.
*
Grade 5-8 EARLY BIRD RATE with payment received by August 31 - $120
Grade 5-8 REGULAR RATE - $140
Grade 5-8 Second Sibling - $115
Grade 5-8 Third Sibling - $90
High School Team Leader - grade 9-10 - $70
High School Team Leader - grade 11-12 - No Fee
If you are using Fundraising Credits toward this membership, please write the amount of credit used below.
Your answer
Please calculate and record the final registration fee associated with this registration.
*
Your answer
Please write your check out to the "Challenge Club of Saint James". Please mail it to the Challenge Club Treasurer: Christie Leduc, 28 Allen Street, Basking Ridge, NJ 07920.
Check Number Associated with this Registration (you may write a single check covering siblings.)
Your answer
If you are registering a High School Team Leader, please provide her email address.
Your answer
Would you like your daughter listed on a membership roster that is distributed to Club parents? The roster will include the member's name, parent names and parent mobile phone numbers.
*
Yes
No
How did you become aware of the Challenge Club? Select all that apply.
*
Through friends who are Challenge Club members.
Announcement at St. James mass
St. James bulletin
St. James School communication
St. James CCD communication
St. James FCC communication
Other:
Required
Thank you for joining the Challenge Club of Saint James! God bless!
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