2017 VBS - Student Registration
Cost is $20 per child, $35 for 2 children, $55 for 3 or more children.

Please send payment to St. Raphael Parish (1154 Chislett St, Pittsburgh PA 15206) or drop in the offertory in an envelope marked "VBS registration". Make checks payable to St. Raphael Parish.

Please also print and complete the student video/photo release form, found on the website, and return to the Parish Center

Parent Name
Your answer
Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Email Address
Your answer
Emergency Contact - name
Your answer
Emergency Contact - phone
Your answer
Names of other adults who have your permission to pick up your child(ren):
Your answer
Child #1
Please list name, grade (2016-2017), t-shirt size (youth sm/m/l, adult s/m/l) and any allergies.
Your answer
Child #2
Please list name, grade (2016-2017), t-shirt size (youth sm/m/l, adult s/m/l) and any allergies.
Your answer
Child #3
Please list name, grade (2016-2017), t-shirt size (youth sm/m/l, adult s/m/l) and any allergies.
Your answer
Child #4
Please list name, grade (2016-2017), t-shirt size (youth sm/m/l, adult s/m/l) and any allergies.
Your answer
We need volunteers! Are you able to help?
If you select yes, Dolores will contact you at the information listed above.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms