Membership Application

CYO membership fee for 2009 - 2010 is $5.00.
Please Complete and Print ALL information

THIS FORM MUST BE COMPLETED BY ALL CYO MEMBERS REGARDLESS OF WHETHER OR NOT YOU HAVE PREVIOUSLY PAID YOUR MEMBERSHIP FEE WITH A SPORT REGISTRATION.

Name:

Address:


Phone #: Grade: Room Number:

MEMBER:
I have read and agree to follow the Saint Jerome CYO Membership Obligations:

Member Signature________________________________ Date:


PARENT:
I have read the St. Jerome CYO Membership Obligations and to hereby give my permission for my child to participate in Saint Jerome's CYO and its functions.

Parent's Signature________________________________ Date:

Emergency Contact
Name Phone Number:


Please fill out, print and sign this form. Return it, along with your membership fee, to school in an enveloped marked CYO Membership. Make checks payable to St. Jerome CYO.

*If you have previously paid your membership fee with a sport registration please indicate which sport (St. Jerome swimming is not a CYO sport).

Volleyball   Soccer    Football   Basketball   Track