Vacation Bible School Registration Form
Please fill out one form per child. Registration closes June 30th at 11:59pm
Email address *
When: July 29 - August 2; 9am - 12pm
Where: St. Thomas the Apostle Catholic Church
530 Elizabeth Street, Ann Arbor, MI 48104
Age: 0-10 years old! (Child care will be provided for 0-2 year olds)
Cost: $30 per child
Payment
This Year's Theme:
Child Information
Name: *
Your answer
Age: *
Your answer
Grade completed:
Your answer
Gender *
T-shirt Size (child sizes) *
Allergies or medical conditions
Your answer
Health Insurance Number (if applicable)
Your answer
Parent/Guardian Name: *
Your answer
Address:
Your answer
Home Phone: *
Your answer
Cell Phone
Your answer
Emergency Contact *
Your answer
Emergency Contact Phone Number: *
Your answer
I understand that reasonable precautions will be taken to safeguard the health and well being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In case of sickness or an accident, I authorize and consent the VBS team, or other associated volunteers of the VBS program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself or other legal guardian(s) cannot be reached. I hereby do release and forever discharge the Diocese of Lansing, and St. Thomas the Apostle Catholic Church from all manners of actions, claims which I or the child made above shall or may have for any reason, arising during my child's attendance of the VBS. Unless other written instruction is submitted, I also consent to allowing my child's image to be recorded, either by photograph or video, and used during the VBS week or for future advertisement of Parish VBS programs. Any other use will require your further consent.
Parent/Guardian Electronic Signature: *
Your answer
Date: *
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If you have any further questions please email Cristina Holder
A copy of your responses will be emailed to the address you provided.
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