• 

• The maximum number of form submissions has been reached. This form is currently not available.

  • Student
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Homeroom REQUIRED (Select One) 2D 2O 3C 3V Please fill out this field.
  • Parent/Guardian
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Email REQUIRED Please fill out this field. Please enter an email address.
  • In case of emergency please contact me at:
  • Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  • Parent/Guardian Permission REQUIRED I give permission for my child to attend the after school activity at Immaculate Conception School that is listed above. Please fill out this field.
  • Registration Fee for Hand Chime Club70.0

  Total:

  Submit

  Proceed to Payment

  This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.