Vacation Bible School 2025

Vacation Bible School 2025
Thank you for your interest in our Vacation Bible School 2025. Vacation Bible School will run from 9am to 12pm daily from Monday, July 28th to Friday, August 1st. Cost for this week long Vacation Bible School is $40 per student and will include refreshments, arts & crafts, t-shirt, etc. For more questions or if you're interested in volunteering please contact the Office of Religious Education: (909)796-4308 or aeflores1027@gmail.com.

**All registrations must include copies of each child's birth certificate if they have not registered in St. Joseph the Worker RE Program in the past**
Student Information

*If you need to register more than 3 students please contact the CCM.
Student 1 Name*

First NameLast Name
Student 1 Birthday*

MonthDayYear
Date
Student 1 Grade by September 1st, 2025*
Student 1 Allergies*
*If student has no allergies please type in N/A
Student 1 T-shirt size*

Extra SmallSmallMediumLargeExtra Large
Student 2 Name

First NameLast Name
Student 2 Birthday

MonthDayYear
Date
Student 2 Grade by September 1st, 2025
Student 2 Allergies
*If student has no allergies please type in N/A
Student 2 T-shirt size

Extra SmallSmallMediumLargeExtra Large
Student 3 Name

First NameLast Name
Student 3 Birthday

MonthDayYear
Date
Student 3 Grade by September 1st, 2025
Student 3 Allergies
*If student has no allergies please type in N/A
Student 3 T-shirt size

Extra SmallSmallMediumLargeExtra Large
Family Information
Parent/Guardian 1 Name*

First NameLast Name
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 1 Phone Number*
Please enter a valid phone number.
Parent/Guardian 2 Name*

First NameLast Name
Parent/Guardian 2 Email*
example@example.com
Parent/Guardian 2 Phone Number*
Please enter a valid phone number.
Emergency Contact
Emergency Contact Full Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship to Student(s)*
Ex: Grandparent, Aunt/Uncle, Family Friend, etc.
Please list the names and phone numbers for any other adults who you give permission to pick the children up. *
Medical Release
Insurance Information*

Insurance Carrier

Insurance Policy #

Name of Policy HolderFamily Physician

Hospital
Yes I have fully answered this Medical Release Form to the best of my knowledge. I also understand that in the event medical intervention is necessary, every attempt will be made to contact immediately the persons listed on this form. If I cannot be reached in an emergency during Religious Education, I give my permission to the physician selected by the activity leader to hospitalize in order to secure medical treatment and/or an injection, anesthesia, or surgery for my child(ren) as deemed necessary.

I have read and fully understand the requirements outlined by St. Joseph the Worker Catholic Church. By signing this form, I accept the requirements stated in this Medical Release Form.
Media Release
I give permission for St. Joseph the Worker Catholic Church to include photos and videos of my child(ren) from church events in St. Joseph the Worker Catholic Church publications including media presentations, brochures, bulletin boards, our website and bulletin.*

Yes, I give permission.No, I do not give permission.
Signature*

Clear
Should be Empty:

Vacation Bible School 2025

Student Information

Family Information

Emergency Contact

Medical Release

Media Release