Vacation Bible School 2022

Vacation Bible School 2022
Thank you for your interest in our Vacation Bible School. Week 1 will be from July 25th to July 29th for grades Kinder to 3rd. Week 2 will be from August 1st to August 5th for grades 4th to 6th. Each week Vacation Bible School will run from 9:00am to 11:30am. Snacks will be provided but no full meals. Cost for this week long Vacation Bible School is $30 per student. Payments can be made online at Online Giving under religious education or in person, appointments are encouraged. For more questions or if you're interested in volunteering please contact the Office of Religious Education: (909)796-4308 or aeflores1027@gmail.com.
Student Information

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

First Name Last Name
Student 1 Birthday *

Month Day Year
Date
Student 1 Grade by September 1st, 2022 *
Student 1 Allergies *
*If student has no allergies please type in N/A
Student 2 Name

First Name Last Name
Student 2 Birthday

Month Day Year
Date
Student 2 Grade by September 1st, 2022
Student 2 Allergies
*If student has no allergies please type in N/A
Student 3 Name

First Name Last Name
Student 3 Birthday

Month Day Year
Date
Student 3 Grade by September 1st, 2022
Student 3 Allergies
*If student has no allergies please type in N/A
Family Information
Parent/Guardian 1 Name *

First Name Last Name
Parent/Guardian 1 Email *
example@example.com
Parent/Guardian 1 Phone Number *
Please enter a valid phone number.
Relationship to Student(s) *
Ex: Mother, Father, Grandmother, etc.
Parent/Guardian 2 Name

First Name Last 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 Name Last Name
Emergency Contact Phone Number *
Please enter a valid phone number.
Relationship to Student(s) *
Ex: Grandparent, Aunt/Uncle, Family Friend, etc.
Medical Release
Insurance Information *

Insurance Carrier

Insurance Policy #

Name of Policy Holder Family 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 *

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Vacation Bible School 2022

Student Information

Family Information

Emergency Contact

Medical Release

Media Release