VBS St. Therese 2019 - Mars and Beyond!
Sign up to go to "Mars and Beyond" using this form!
Dates: June 18, 19, 20. Drop off 8-8:30am. Pick up 12-12:30pm.
Breakfast and lunch served daily. No fee to attend!
Participant #1 First and Last Name & Gender *
Your answer
Allergies & Medical Conditions Participant #1 *
Your answer
Grade last completed - Participant #1 *
Days Attending - Participant #1
Participant #2 First and Last Name & Gender
Your answer
Allergies & Medical Conditions Participant #2
Your answer
Grade last completed - Participant #2
Days Attending - Participant #2
Participant #3 First and Last Name & Gender
Your answer
Allergies & Medical Conditions Participant #3
Your answer
Grade last completed - Participant #3
Days Attending - Participant #3
Participant #4 First and Last Name & Gender
Your answer
Allergies & Medical Conditions Participant #4
Your answer
Grade last completed - Participant #4
Days Attending - Participant #4
Parent(s) Name(s) *
Your answer
Address *
Your answer
Email - for important reminders and announcements
Your answer
Phone Numbers where you can be reached during VBS *
Your answer
In case of emergency, when a parent cannon be reached, contact name and phone: *
Your answer
Health Insurance Company *
Your answer
Policy Number *
Your answer
Group
Your answer
Contract #
Your answer
I give permission for VBS staff to administer basic first aid to the above named children in the event of injury. In the event of emergency, if I cannot be reached, I authorize the listed emergency contact to act on my behalf. If I or the listed emergency contact cannot be reached, I authorized the VBS staff to obtain the necessary medical treatment and/or services. I understand that I am responsible for all expenses for emergency services. *
Photo Release: I hereby grant St. Therese Parish permission to copyright and use photographs or video in print and online communications including parish monitors, website, social media, and bulletins. I understand my child's name will NOT be included in any such communications *
Permission to Attend: I give permission for my child(ren) listed above to attend the Vacation Bible School listed. I understand that the information I give for this registration will only be used by the VBS hosting church and that all registration information will be removed from the site by December 31 of this year. *
Parent Signature & Date *
Your answer
Release Information: You have my permission to release the above listed children to the authorized adults below (include phone numbers for each):
Your answer
Parents Name and Phone Number *
Your answer
Parent Signature & Date
Your answer
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