Vacation Bible School

St. Josephs Catholic Church
August 7-11, 2017
8:30-11:30a
Child 1 Name
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Child 1 Age
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Child 1 Entering Grade
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Child 2 Name
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Child 2 Age
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Child 2 Entering Grade
Child 3 Name
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Child 3 Age
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Child 3 Entering Grade
Child 4 Name
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Child 4 Age
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Child 4 Entering Age
Parent's Name
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Street Address
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City
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State
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Zip Code
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Telephone number where parent can be reached during VBS
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Email
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Any special concerns for your child (i.e. allergies, medications, or behavior)
Please specify the name of the child for each concern.
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I understand that I will have to pay $25 upon registration ONLINE.
UPON SUBMISSION OF THIS FORM YOU WILL RECEIVE A LINK TO WESHARE OUR SECURE ONLINE PARISH PAYMENT SYSTEM TO PAY YOUR $25 FEE. Check or cash payments are also accepted. ALL PAYMENTS REQUIRED BY August 1st.
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WE NEED VOLUNTEERS
We are looking for adult and student (grade 7-12) volunteers.
Yes I am interested in volunteering for part or all of the VBS week.
Fill in name and phone number. For more information contact Mandy Foss 218-326-2843 X 15
PARENT/LEGAL GUARDIAN PERMISSION SLIP AND INDEMNITY AGREEMENT
Your son/daughter, ward, ________Name mentioned above_________ is eligible to participate in a school/parish sponsored activity that requires permission. This activity will take place under the guidance and supervision of employees/volunteers from St. Joseph’s Community (parish/school).
A brief description of the activity is as follows: Vacation Bible School - August 7-11, 2017
TYPE OF ACTIVITY: Vacation Bible School
DESCRIPTION OF ACTIVITY: See above
DATE AND TIME OF ACTIVITY: August 7-11, 2017 8:30-11:30am
STUDENT COST (IF APPLICABLE): $25.00
Parent/Legal Guardian Signature: *
Parent/ Legal Guardian Signature
I consent to the participation of my child/ward in the above named activity. In consideration for my child/ward's participation, I agree to reimburse and indemnify the above named parish/school (understood to include the Diocese of Duluth) for all reasonable legal and court fees incurred by parish/school in defending a lawsuit that I or my child/ward may bring against the parish/school which relates to the above named activity if the parish/school is found not legally liable by the courts and prevails in the lawsuit. If the parish/school is found liable for the injuries sustained by child/ward, this paragraph will not apply. I certify that I have an understanding of this agreement and the risks and hazards associated with the activity described above that my child/ward will be participating in. I further understand that I had the opportunity to fully discuss this agreement with a representative of the parish/school to clarify any concerns or questions about the activity or this agreement that I may have had.
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Emergency Contact
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Emergency Contact Phone Number
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Emergency Medical Treatment
In the event of an emergency, I give permission to transport my child/ward to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. PLEASE INITIAL BELOW.
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Alternative Emergency Contact Name
In the event of an emergency, if you are unable to reach me at the numbers above please contact:
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Alternative Emergency Phone Number
In the event of an emergency, if you are unable to reach me at the numbers above please contact:
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Medical Insurance Company
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Policy Number
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