Step Up Day Online Registration Form

Student Name*
School Currently Attending*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Please indicate any medical/physical concerns and/or allergies that we should be aware of:
The faculty and staff of Joliet Catholic Academy is hereby given permission to give normal first aid to my child. I understand that JCA is not to be held liable for the administration of such health care. I release JCA and all of its employees from harm and liability that comes from this visit to JCA. In the event that parents/guardians cannot be reached, I give my permission to JCA to seek emergency care for my child.
- Parent/Guardian Electronic Signature. I Agree (Click Box)

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