2019 Saint Joseph Church - Vacation Bible School
2019 Online Registration - One Form Per Child

July 8-12, 2019 / 8:30 am - 1:00 pm / 4 Year Olds - Rising 5th Graders

Email address *
Student LAST NAME *
Your answer
Student FIRST NAME *
Your answer
Student NICKNAME *
Your answer
Gender *
Grade for School Year 2019-2020 *
List Allergies *
Your answer
List Any Medical Issues or Special Needs *
Your answer
Parent Full Name *
Your answer
Parent Home Address *
Your answer
Parent Email *
Your answer
Parent Daytime Phone Number *
Your answer
Parent Home Phone Number *
Your answer
Parent Cellular Number *
Your answer
Emergency Contact (Full Name) *
Your answer
Emergency Contact Phone Number *
Your answer
Alternate Pickup (Full Name) *
Your answer
Alternate Pickup Phone Number *
Your answer
MEDICAL RELEASE: I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me. *
PHOTO RELEASE: The Diocese of Richmond requires permission from parents/guardians for public release of any photo of their student. This is to include newspaper, television, advertisement and/or newsletters. I give my permission to copyright and use photographs and videos taken at VBS. *
A copy of your responses will be emailed to the address you provided.
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