Neon Night Registration Form

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York Catholic is hosting Neon Night for students in grades 4-5-6 on Tuesday, November 22, from 6-8 PM. Our Futures will enjoy a night of games, snacks, and glow stick fun! Cost is $10 and is payable at the door. Please complete the information below to register (one registration form per child) by November 18th. We can't wait to see our Futures glow!

Event Supervisor:
David Butler, Jr.

Director of Admission & Enrollment

College & Career Advisor

dbutler@yorkcatholic.org or 717-846-8871 x1354

Student Name (First and Last) *

Student's Current School *

Holy Trinity

St. John the Baptist

St. Joseph York

St. Rose of Lima

Other

Student's Current Grade *

Grade 4

Grade 5

Grade 6

Student's T-shirt Size *

Youth Small

Youth Medium

Youth Large

Youth X-Large

Adult Small

Adult Medium

Adult Large

Adult X-Large

Parent Name *

Parent Phone *

Parent Email *

Parent Home Address *

Emergency Contact Name *

Emergency Contact Phone *

Student Medical Conditions *

Please list any medical conditions it would be important for the event supervisor to know about the participant. If none, please type NONE.

Waiver *

I hereby request the participation of my child, named above, in the Neon Night event described above. I understand that my child will be under the supervision of the designated school employee on the stated dates. I hereby agree, on behalf of the named student and his other parent or legal guardians, to waive any claims for liability against this school, the Diocese of Harrisburg (and any diocesan or school officers, agents or employees) which may arise from the participation of the named student in the above-described event.

The parent or guardian named above should check here to consent to the above Waiver

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