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Vacation Bible School Registration

"A Wilderness Adventure Through the Sacraments"

Come along on a Wilderness Adventure Through the Sacraments and hold Jesus in your heart.


WHO: Kids ages 4-12

WHERE: St. Jude Parish Hall

WHEN: July 22 - 26, 2019

TIME: 9 AM - 12 PM each day

COST: $45/child

REGISTRATION DEADLINE: July 1, 2019

For further information, contact Stacey Porter at staceylporter@gmail.com

Child's Information
Please complete all information requested.
First and Last Name of Child
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Please include first and last name of your child. Submit one registration for each child.
Sex
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Age
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Grade Level for upcoming school year
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Please select the grade your child will be in the upcoming school year.
T-shirt size
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Allergies and Medical Conditions
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Please list all allergies and/or medical conditions of which we should be aware. If none, please indicate by typing "None" in the box.
Health Insurance Plan and ID #
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Please provide insurance information including name of company and policy number in space provided.
Family Information
Parent/Guardian's First and Last Names
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Address
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Primary Phone Number --
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Secondary Phone Number (if applicable) --
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Primary E-mail
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Secondary E-mail (if applicable)
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Emergency Contact
If different from above.
Emergency Contact First and Last Name
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Emergency Contact Phone Number --
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Emergency Contact E-mail
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Legal Consent
I consent.
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I understand that reasonable precautions will be taken to safeguard the health and well being of the participants of VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or accident, I authorize and consent to 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 I or another legal guardian cannot be reached. I hereby do release and forever discharge the Archdiocese and Parish from all manners of actions or claims, which I or the child named avove shall or may have for any reason, arising during my child's attendance at VBS. Unless other written instruction is submitted, I also consent to allow my child's image to be recorded, either by photograph or video, and used during the VBS week or for future advertisement of the Parish VBS program. Any other use will require your further consent.
First and Last Name
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Please type the first and last name of the person completing this form.
Payment
The registration fee for VBS is $45.00 per child. Please continue on to our online giving site to pay for your child.