Vacation Bible School at St. Ann

Name of person completing this form REQUIRED Please fill out this field. Please enter valid data.

Parent or Guardian Name(s) REQUIRED Please fill out this field. Please enter valid data.

Parent or Guardian Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Parent or Guardian E-mail Address Please enter an email address.

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone REQUIRED Please fill out this field. Please enter a phone number.

Number of Children REQUIRED
Enter the number of children you wish to register, then complete the information for each child before clicking the submit button, below.
Please fill out this field.
Child 1
- Name REQUIRED Please fill out this field. Please enter valid data.
- Sex REQUIRED M F Please fill out this field.
- Age REQUIRED Please fill out this field. Please enter an integer (number).
- Grade Entering this Fall REQUIRED Please fill out this field.
- Shirt Size REQUIRED Please fill out this field.
- Allergies or medical conditions Please enter valid data.
- Health Insurance # (if applicable) Please enter valid data.
Child 2
- Name REQUIRED Please fill out this field. Please enter valid data.
- Sex REQUIRED M F Please fill out this field.
- Age REQUIRED Please fill out this field. Please enter an integer (number).
- Grade Entering this Fall REQUIRED Please fill out this field.
- Shirt Size REQUIRED Please fill out this field.
- Allergies or medical conditions Please enter valid data.
- Health Insurance # (if applicable) Please enter valid data.
Child 3
- Name REQUIRED Please fill out this field. Please enter valid data.
- Sex REQUIRED M F Please fill out this field.
- Age REQUIRED Please fill out this field. Please enter an integer (number).
- Grade Entering this Fall REQUIRED Please fill out this field.
- Shirt Size REQUIRED Please fill out this field.
- Allergies or medical conditions Please enter valid data.
- Health Insurance # (if applicable) Please enter valid data.
Child 4
- Name REQUIRED Please fill out this field. Please enter valid data.
- Sex REQUIRED M F Please fill out this field.
- Age REQUIRED Please fill out this field. Please enter an integer (number).
- Grade Entering this Fall REQUIRED Please fill out this field.
- Shirt Size REQUIRED Please fill out this field.
- Allergies or medical conditions Please enter valid data.
- Health Insurance # (if applicable) Please enter valid data.
Child 5
- Name REQUIRED Please fill out this field. Please enter valid data.
- Sex REQUIRED M F Please fill out this field.
- Age REQUIRED Please fill out this field. Please enter an integer (number).
- Grade Entering this Fall REQUIRED Please fill out this field.
- Shirt Size REQUIRED Please fill out this field.
- Allergies or medical conditions Please enter valid data.
- Health Insurance # (if applicable) Please enter valid data.

I understand that reasonable precautions will be taken to safeguard the health and well-being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent 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 myself or other legal guardian(s) cannot be reached. I hereby do release and forever discharge this Diocese, Parish and/or Organization from all manners of actions, claims which I or the child named above shall or may have for any reason, arising during my child’s attendance of the VBS. Unless other written instruction is submitted, I also consent to allowing my child’s image to be recorded, either by photograph or video, and used during the VBS week or for future advertisement of Parish VBS programs. Any other use will require your further consent.

I Agree Please select this field.