SCUBA VBS Registration
$40.00 per student prek - entering 6th grade. Registration isn't complete until payment received.
Please complete additional registration form for each child you are registering.
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Email *
First and Last name of Child *
Age of Child *
Grade entering *
Gender *
Child Allergies. If no allergies, please type "none" *
T-shirt Size *
Parent/Guardian First and Last Name *
Parent/Guardian phone number *
Parent/Guardian Home Address, include city and zip code. *
Emergency Contact Name, (First and Last) in the event we are unable to reach parent/guardian. *
Emergency Contact Phone number, in the event we are unable to reach parent/guardian. *
Additional adults that may pick up my child.
In case of emergency, I grant permission to OLPS Church - Chalmette, to provide and/or obtain medical attention for my child/children. I realize that recommendations of emergency medical service will determine which hospital my child will be taken to in the event I cannot be reached. I further authorize medical personnel of the hospital to care for and treat my child. *
I grant permission for Our Lady of Prompt Succor - Chalmette to use my child/children's name and/or photograph for use in parish flyers, parish bulletin, parish website or social media. *
Electronic Signature
by typing my name below, I certify that all information provided in this form is accurate and I agree with provided answers.
Registration is not complete until payment has been received. Please pay using the link below, or drop payment off to the parish office. Please label VBS and include the student name if dropping off. 
($40.00 per student)

A copy of your responses will be emailed to the address you provided.
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