Family Honor Real Love & Real Life Program OUR LADY OF PERPETUAL HELP CATHOLIC PARISH March

9th & 10th, 2012

Please return this completed form to OLPH Church (501 S. Moore Rd. Chatt., TN 37412), and your check for $25.00 to OLPH by March 1, 2012. Registration fee is non-refundable and space is limited to the first 40 families.

Hosted at Our Lady of Perpetual Help in the PLC

Please print (1 per participant)

Student Name: _______________________For Name Tag: ____________________________ Age: ______ Grade: _____ Sex: _________ Race: _________ Special Needs? _____________ Parent(s) or Guardian Name(s): __________________________________________________
(If possible both parents should attend this program)

For Name Tag(s): ________________________________________________________ Mailing address: _______________________________________________________________ City: _______________________________ State: ________________ Zip: _______________ Phone: H: _________________ Wk: _________________ e-mail: _______________________ IMPORTANT: Because Family Honor programs are designed to help enhance parent/ child communication and connectedness, the parent(s) or adult guardian is required to attend this program with your child. Thank you for your willingness to spend time in this program nurturing your relationship with your son or daughter!
Note: This information is for statistical purposes only. We do not rent or sell our list to any individual, group or organization.

Parents Marital Status: (Circle One) Married Single Divorced Separated Widowed

Parents Education: (Circle last year completed for each spouse) Father Mother High School High School Some College Some College College Grad. College Grad. Post Grad. Post Grad.

Remember to mark you calendar for Family Honors Real Love & Real Life. Please detach this section and post it on your refrigerator. Days and Dates: Friday, March 9th & Saturday, March 10th, 2012 Registration & Friday: 6:45-7:00 pm Refreshments: Saturday: 8:30-9:00 am LUNCH PROVIDED ON SITE Program Time: Friday: 7:00 pm-9:15 pm Saturday: 9:00 am to 4:00 pm Location: OLPH PLC, 501 South Moore Road, Chattanooga, TN 37412 Contact: Mary Pat Haywood 706-459-6391 or Jan OBoyle 706-226-9110