2018 Good Shepherd and St. Mary Vacation Bible School Registration
June 11-15, 2018
Vacation Bible School for Kids
9:00AM—Noon at:
Good Shepherd Catholic Church
N88 W17658 Christman Road
Menomonee Falls, WI

Participants: Children entering K3-6th Grade in the 2018-2019 School Year
Children must have turned 3 no later than 12/31/2017 and be potty trained.

Volunteer Opportunities:
Youth Crew Leaders: Students entering 7th grade—College (2018-2019 school year)
Adult Leaders/Volunteers: Day Care for children under age 4 will be provided for adult leaders/volunteers.

Early Bird Special: Register and pay by May 15th: $35/child ($70 max/family)
Registrations received May 16—May 31: $40/child ($80 family max)
NO REGISTRATIONS ACCEPTED AFTER MAY 31, 2018
Return payment (made payable to Good Shepherd) to either St. Mary or Good Shepherd Christian Formation Offices
no later than May 31st (May 15th for early bird discount)

Email address *
Child 1 First and Last Name
Your answer
Child 1 Grade (Fall 2018)
Child 2 First and Last Name
Your answer
Child 2 Grade (Fall 2018)
Child 3 First and Last Name
Your answer
Child 3 Grade (Fall 2018)
Child 4 First and Last Name
Your answer
Child 4 Grade (Fall 2018)
Parish or Friend Of *
Your answer
Optional: Would you like a music CD or digital download for an extra $8?
PARENT/GUARDIAN FULL NAME *
Your answer
HOME ADDRESS *
Your answer
ALTERNATE EMAIL ADDRESS
Your answer
HOME PHONE
Your answer
CELL PHONE
Your answer
ALTERNATIVE CONTACT (If unable to reach you) *
Your answer
ALTERNATIVE CONTACT BEST PHONE DURING EVENT *
Your answer
PHYSICIAN'S FULL NAME *
Your answer
PHYSICIAN'S PHONE *
Your answer
NAME OF MEDICAL INSURANCE *
Your answer
MEDICAL INSURANCE POLICY NUMBER *
Your answer
PERTINENT MEDICAL CONDITIONS
Your answer
INHALER/EPI-PEN
ANY FOOD ALLERGIES TO BE AWARE OF?
Your answer
Youth Volunteer 1 - Name
Your answer
Youth Volunteer 1 Grade (Fall 2018)
Youth Volunteer 1 Email
Your answer
Youth Volunteer 1 - Days Available
Youth Volunteer 2 - Name
Your answer
Youth Volunteer 2 Grade (Fall 2018)
Youth Volunteer 2 Email
Your answer
Youth Volunteer 2 - Days Available
Adult Volunteer Name
Your answer
Adult Volunteer Email
Your answer
Adult Volunteer days available
Do you need child care for children under 4 (adult volunteers only)?
If so, how many children and what age(s) are the children?
Your answer
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