2021-2022 Squire Rose Registration

Squire Rose 2021-2022 Registration Form & Payment

Join us for another year of service and friendship
General meetings are held the on the third Thursday from 7:00p-8:30p. A meal and fellowship will be provided from 6:00p-7:00p. Many additional opportunities available to serve our parish and community outside of general meetings.

Annual Registration Includes...

Squire Rose designed T-shirt
Meals prior to each monthly general meeting
Supplies for themed general meetings
Meals/snacks during service events
Supplies for service projects and crafts
Award pins for service projects completed
May crowning banquet
End of year service awards
... and so much more!

Rose First Name

Rose Last Name

Birthdate

Age

Address

City

State

Zip Code

Rose Email

Rose Cell Phone

Grade

Name of School

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Cell Phone

Parish

Parish City

Diocese

Year(s) Registered @ Parish

Emergency Contact

Emergency Contact Cell Phone

Relation to Emergency Contact

Is Contact Authorized for Pick Up?

Primary Care Physician/Practice

Primary Physician Phone

Preferred Emergency Hospital

Allergies? Please explain.

Upload Insurance Card

Upload File

Upload Rose Photo (Optional)

Upload File

I agree to the CONSENT TO PARTICIPATE AND RELEASE USAGE OF AUDIO/VISUAL RECORDING AND PHOTOGRAPHYView terms here

I agree to AUTHORIZE CONSENT TO TREAT A MINORView terms here

I agree to the COVID-19 STATEMENTView terms here

I agree that my daughter will participate in at least one of our major service projects (Holiday Bazaar, Christmas, Easter, Mother's Day Tea). I understand that a sign up will be shared for these service opportunities at a later time.

I understand that I will be asked to help chaperone one monthly meeting (3rd Thurs) and that I could be asked to assist with room set up, supervise food service/meeting activities and/or assist with room clean up. I understand that a sign up was made available to me at the beginning of the service year.View sign up sheet here

Your Signature (First and Last Name)

Thank you for registering!